Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 3981 | CO |
N | 111NI0900X | Internist | 3981 | CO |
Y | 111NN0400X | Neurology | 3981 | CO |
N | 111NR0400X | Rehabilitation Chiropractor | 3981 | CO |
N | 111NS0005X | Chiropractic Sports Physician | 3981 | CO |
NPI | 1902061732 |
---|---|
Provider Name | Dr. Mark Reid |
First Address | Fort Collins, CO 80525-3155 |
Second Address | Fort Collins, CO 80525-3155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2008 |
Last Update Date | 21/07/2008 |