Provider Demographics
NPI:1194809392
Name:REED, PAUL A (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
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 1:13800 NE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2704
Mailing Address - Country:US
Mailing Address - Phone:360-574-5944
Mailing Address - Fax:360-574-6430
Practice Address - Street 1:14403 NE FOURTH PLAIN BLVD STE 110
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-5001
Practice Address - Country:US
Practice Address - Phone:630-468-1824
Practice Address - Fax:630-468-1478
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB24001Medicare ID - Type Unspecified
WAU69168Medicare UPIN