Provider Demographics
NPI:1457429276
Name:MCREYNOLDS, THERESA ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ANNE
Last Name:MCREYNOLDS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 PITNEY RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08205
Mailing Address - Country:US
Mailing Address - Phone:609-432-5881
Mailing Address - Fax:
Practice Address - Street 1:547 PITNEY RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08203
Practice Address - Country:US
Practice Address - Phone:609-432-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00615700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor