Provider Demographics
NPI:1154432417
Name:REED, PHILIP (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
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 1:705 S OAKWOOD RD
Mailing Address - Street 2:SUITE A7
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-6200
Mailing Address - Country:US
Mailing Address - Phone:580-234-0166
Mailing Address - Fax:580-234-2766
Practice Address - Street 1:705 S OAKWOOD RD
Practice Address - Street 2:SUITE A7
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-6200
Practice Address - Country:US
Practice Address - Phone:580-234-0166
Practice Address - Fax:580-234-2766
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$Medicare PIN