Healthcare Provider Details

I. General information

NPI: 1598739112
Provider Name (Legal Business Name): WM RYAN REYNOLDS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 W CENTRE AVE STE 3
PORTAGE MI
49024-5356
US

IV. Provider business mailing address

1508 W CENTRE AVE STE 3
PORTAGE MI
49024-5356
US

V. Phone/Fax

Practice location:
  • Phone: 269-343-2667
  • Fax:
Mailing address:
  • Phone: 269-343-2667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009081
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberWR009081
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: