Provider Demographics
NPI:1194293258
Name:REYNOLDS, TRAVIS (DC)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
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 1:14051 BURNHAVEN DR STE 104
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4400
Mailing Address - Country:US
Mailing Address - Phone:952-492-9043
Mailing Address - Fax:
Practice Address - Street 1:14051 BURNHAVEN DR STE 104
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4400
Practice Address - Country:US
Practice Address - Phone:952-492-9043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6525111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation