Provider Demographics
NPI:1902061732
Name:REID, MARK (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:REID
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 E HORSETOOTH RD
Mailing Address - Street 2:BUILDING #2 SUITE 201
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 E HORSETOOTH RD
Practice Address - Street 2:BUILDING #2 SUITE 201
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3155
Practice Address - Country:US
Practice Address - Phone:970-204-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3981111NI0900X, 111NN0400X, 111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111NI0900XChiropractic ProvidersChiropractorInternist
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician