MEDICARE: REYNOLDS CHIROPRACTIC, LLC

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

General Provider Information

NPI Number	:	1225756067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REYNOLDS CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	1231 MAPLE AVE SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24016-4707
Country	:	US
Telephone Number	:	540-342-9445
Fax Number	:	540-342-9446

Provider Business Practice Location Address
First Line	:	1231 MAPLE AVE SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24016-4707
Country	:	US
Telephone Number	:	540-342-9445
Fax Number	:	540-342-9446

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DALE EUGENE REYNOLDS
Credential	:	DC
Telephone Number	:	540-342-9445

Provider Enumeration Date	:	08/18/2022
Last Update Date	:	08/18/2022

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