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General NPI Number Information
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NPI Number | 1063550143
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Entity Type | Organization
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Legal Business Name | REYNOLDS CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 8150 MOORSBRIDGE RD SUITE B
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City | PORTAGE
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State | MI
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Zip | 49024-7419
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Country | US
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Telephone | 269-343-2667
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2550
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City | PORTAGE
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State | MI
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Zip | 49081-2550
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Country | US
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Telephone | 269-343-2667
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WM RYAN REYNOLDS
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Credential | D.C.
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Telephone | 269-343-2667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | WR009081
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License Number State | MI
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