Provider Demographics
NPI:1356461347
Name:REYNOLDS, WILLIAM B (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:BRENT
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:416 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3841
Mailing Address - Country:US
Mailing Address - Phone:631-525-2943
Mailing Address - Fax:
Practice Address - Street 1:416 MAIN ST
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3841
Practice Address - Country:US
Practice Address - Phone:631-525-2943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006364-1171100000X
NYX010768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC107682Medicare ID - Type Unspecified