Provider Demographics
NPI:1588716435
Name:REEDER, JOHN JAY (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JAY
Last Name:REEDER
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 1:112 W DOTY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6006
Mailing Address - Country:US
Mailing Address - Phone:843-871-5055
Mailing Address - Fax:843-871-5051
Practice Address - Street 1:112 W DOTY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6006
Practice Address - Country:US
Practice Address - Phone:843-871-5055
Practice Address - Fax:843-871-5051
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC 1246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor