Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIA-329 | ID |
NPI | 1003927286 |
---|---|
Provider Name | Dr. Bradley Scott Reed |
First Address | Coeur D Alene, ID 83814-2300 |
Second Address | Coeur D Alene, ID 83814-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 20/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002479000 | (05) | ID |
C3290 | BLUE CROSS (01) | ID |
T44427 | (02) | ID |