Provider Demographics
NPI:1073724621
Name:UY, DOMINADOR REYNO JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DOMINADOR
Middle Name:REYNO
Last Name:UY
Suffix:JR
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 1:1930 LAND O LAKES BLVD STE 16
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-2924
Mailing Address - Country:US
Mailing Address - Phone:813-909-7171
Mailing Address - Fax:813-909-7184
Practice Address - Street 1:1930 LAND O LAKES BLVD STE 16
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-2924
Practice Address - Country:US
Practice Address - Phone:813-909-7171
Practice Address - Fax:813-909-7184
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7765Medicare ID - Type Unspecified