Provider Demographics
NPI:1679919708
Name:REYNOLDS, TYLER DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:DANIEL
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 1:2474 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4019
Mailing Address - Country:US
Mailing Address - Phone:920-728-2930
Mailing Address - Fax:
Practice Address - Street 1:2474 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4019
Practice Address - Country:US
Practice Address - Phone:920-728-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012435111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation