Provider Demographics
NPI:1194439208
Name:REED, PRESTON DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:DOUGLAS
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 1:1204 N GRADY ST
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-2535
Mailing Address - Country:US
Mailing Address - Phone:580-482-2313
Mailing Address - Fax:877-796-4286
Practice Address - Street 1:116 W 4TH ST
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:OK
Practice Address - Zip Code:73651-4010
Practice Address - Country:US
Practice Address - Phone:580-726-2900
Practice Address - Fax:877-796-4286
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor