Provider Demographics
NPI:1063768679
Name:REYNOLDS, ROSS MICHAEL WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:MICHAEL WILLIAM
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:ROCK RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:51246-1338
Mailing Address - Country:US
Mailing Address - Phone:712-472-2481
Mailing Address - Fax:712-472-2481
Practice Address - Street 1:206 S UNION ST
Practice Address - Street 2:
Practice Address - City:ROCK RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:51246-1338
Practice Address - Country:US
Practice Address - Phone:712-472-2481
Practice Address - Fax:712-472-2481
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007559111N00000X
MN5696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor