MEDICARE: DR. JEFFREY SCOTT REYNOLDS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	6473	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	609220	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1104854306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY SCOTT REYNOLDS D.C.

Provider Business Mailing Address
First Line	:	10221 DESERT SANDS ST
Second Line	:	SUITE 206
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-3959
Country	:	US
Telephone Number	:	210-738-0771
Fax Number	:	210-342-1004

Provider Business Practice Location Address
First Line	:	10221 DESERT SANDS ST
Second Line	:	SUITE 206
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-3959
Country	:	US
Telephone Number	:	210-738-0771
Fax Number	:	210-342-1004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/08/2007

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