Provider Demographics
NPI:1104854306
Name:REYNOLDS, JEFFREY SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
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 1:10221 DESERT SANDS ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3959
Mailing Address - Country:US
Mailing Address - Phone:210-738-0771
Mailing Address - Fax:210-342-1004
Practice Address - Street 1:10221 DESERT SANDS ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3959
Practice Address - Country:US
Practice Address - Phone:210-738-0771
Practice Address - Fax:210-342-1004
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609220OtherBC/BS
TX609663Medicare ID - Type Unspecified
TXU56840Medicare UPIN