Provider Demographics
NPI:1942587811
Name:REYNOLDS PAIN & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:REYNOLDS PAIN & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WULSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-625-2600
Mailing Address - Street 1:35 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2174
Mailing Address - Country:US
Mailing Address - Phone:973-625-2600
Mailing Address - Fax:
Practice Address - Street 1:1572 SUSSEX TPKE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-1822
Practice Address - Country:US
Practice Address - Phone:973-625-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty