MEDICARE: REYNOLDS CHIROPRACTIC INC

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	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1518569607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REYNOLDS CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	PO BOX 1176
Second Line	:
City	:	CARDIFF
State	:	CA
Zip	:	92007-7176
Country	:	US
Telephone Number	:	858-509-7999
Fax Number	:

Provider Business Practice Location Address
First Line	:	11340 W OLYMPIC BLVD STE 138
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1611
Country	:	US
Telephone Number	:	310-477-3335
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	TANYA MARIE REYNOLDS
Credential	:
Telephone Number	:	310-477-3335

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	11/12/2020

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