Provider Demographics
NPI:1003902206
Name:REYNOLDS, MITCH L (DC)
Entity Type:Individual
Prefix:DR
First Name:MITCH
Middle Name:L
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 1:222 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-1669
Mailing Address - Country:US
Mailing Address - Phone:507-825-2214
Mailing Address - Fax:
Practice Address - Street 1:222 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1669
Practice Address - Country:US
Practice Address - Phone:507-825-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04016009Medicaid
MN228L3PIOtherBLUECROSS BLUESHIELD
MN228L3PIOtherBLUECROSS BLUESHIELD