Provider Demographics
NPI:1194712463
Name:REYNOLDS, HENRY M (DCPA)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:M
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DCPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 BIRD RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5383
Mailing Address - Country:US
Mailing Address - Phone:305-662-2071
Mailing Address - Fax:305-662-9587
Practice Address - Street 1:5801 BIRD RD
Practice Address - Street 2:SUITE E
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5383
Practice Address - Country:US
Practice Address - Phone:305-662-2071
Practice Address - Fax:305-662-9587
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381956600Medicaid
FL1194712463OtherP10
FL22452OtherBLUE CROSS BLUE SHEILD