Provider Demographics
NPI:1346068848
Name:HYDE, REAGAN (DC)
Entity type:Individual
Prefix:DR
First Name:REAGAN
Middle Name:
Last Name:HYDE
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 1:242 LAKOTA DR
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-6137
Mailing Address - Country:US
Mailing Address - Phone:270-206-1557
Mailing Address - Fax:
Practice Address - Street 1:242 LAKOTA DR
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-6137
Practice Address - Country:US
Practice Address - Phone:270-206-1557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY290885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor