Provider Demographics
NPI:1720082589
Name:REYNOLDS, JON JEFFREY (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:JEFFREY
Last Name:REYNOLDS
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 1:1019 S COLLEGIATE DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-6309
Mailing Address - Country:US
Mailing Address - Phone:903-785-4900
Mailing Address - Fax:903-785-0022
Practice Address - Street 1:1019 S COLLEGIATE DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6309
Practice Address - Country:US
Practice Address - Phone:903-785-4900
Practice Address - Fax:903-785-0022
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0055349OtherBLUE LINK
TX608060OtherBLUE CROSS BLUE SHIELD
TXP00170881OtherRAILROAD MEDICARE
TX608060OtherBLUE CROSS BLUE SHIELD
TXB0055349Medicare UPIN