Patrick David Reida, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC24249 Issued in CA

Practice address

603 W 6TH St
San Pedro, CA 90731-2523

Phone

(310) 514-0777

Fax

(310) 514-2777

NPI assigned

Oct 24, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Patrick David Fowler Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487635200000",
    "number": "1558445890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 W 6TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312523",
            "telephone_number": "310-514-0777",
            "fax_number": "310-514-2777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 W 6TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907312523",
            "telephone_number": "310-514-0777",
            "fax_number": "310-514-2777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REIDA",
        "first_name": "PATRICK",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2017-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC24249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PATRICK",
            "last_name": "FOWLER",
            "middle_name": "DAVID",
            "credential": "DC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Chiropractor in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.