Provider Demographics
NPI:1871566141
Name:REED, BRETT KEVIN (DC)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:KEVIN
Last Name:REED
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 OLIVEWOOD DR
Mailing Address - Street 2:STE D
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348
Mailing Address - Country:US
Mailing Address - Phone:209-726-4646
Mailing Address - Fax:209-726-4630
Practice Address - Street 1:1190 OLIVEWOOD DR
Practice Address - Street 2:STE D
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348
Practice Address - Country:US
Practice Address - Phone:209-726-4646
Practice Address - Fax:209-726-4630
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U82608Medicare UPIN
CADC0264761Medicare ID - Type Unspecified