Provider Demographics
NPI:1417226010
Name:REYNOLDS, MELISSA ANN (DC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 S MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2236
Mailing Address - Country:US
Mailing Address - Phone:727-754-2663
Mailing Address - Fax:727-754-2225
Practice Address - Street 1:1501 S MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2236
Practice Address - Country:US
Practice Address - Phone:727-754-2663
Practice Address - Fax:727-754-2225
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor