Provider Demographics
NPI:1295978013
Name:REYNOLDS, GARTH (LAC)
Entity type:Individual
Prefix:
First Name:GARTH
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:736 BOXWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6406
Mailing Address - Country:US
Mailing Address - Phone:303-834-8141
Mailing Address - Fax:720-441-0487
Practice Address - Street 1:600 S AIRPORT RD BLDG A STE G
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-1820
Practice Address - Country:US
Practice Address - Phone:303-834-8141
Practice Address - Fax:720-441-0487
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1477171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist