Provider Demographics
NPI:1992992713
Name:REYNOLDS-HILLIARD, WENDY J (DC)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:J
Last Name:REYNOLDS-HILLIARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:J
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1479 FORCE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-1709
Mailing Address - Country:US
Mailing Address - Phone:908-451-2195
Mailing Address - Fax:
Practice Address - Street 1:46161 WESTLAKE DR
Practice Address - Street 2:SUITE 330
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5871
Practice Address - Country:US
Practice Address - Phone:908-451-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00638300111N00000X
VA0104556745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor