Provider Demographics
NPI:1790738623
Name:RENO, ANDREW LEWIS (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEWIS
Last Name:RENO
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 1:4500 PLANK RD
Mailing Address - Street 2:SUITE 1022
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-0120
Mailing Address - Country:US
Mailing Address - Phone:540-785-0200
Mailing Address - Fax:540-785-0660
Practice Address - Street 1:4500 PLANK RD
Practice Address - Street 2:SUITE 1022
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-0120
Practice Address - Country:US
Practice Address - Phone:540-785-0200
Practice Address - Fax:540-785-0660
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2101714OtherMAMSI
VA2740701OtherAETNA
VA2101714OtherALLIANCE
VA434855OtherANTHEM
VA505767OtherNVPPO
VA542053575OtherGREAT WEST
VAS974-0001OtherCAREFIRST
VA505767OtherNVPPO