Provider Demographics
NPI:1770528051
Name:MCREYNOLDS, LOREN E (DC)
Entity type:Individual
Prefix:DR
First Name:LOREN
Middle Name:E
Last Name:MCREYNOLDS
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 1:1113 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-7637
Mailing Address - Country:US
Mailing Address - Phone:937-393-9609
Mailing Address - Fax:937-393-9606
Practice Address - Street 1:1460 JEFFERSON STREET
Practice Address - Street 2:SUITE A
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-0011
Practice Address - Country:US
Practice Address - Phone:937-981-1992
Practice Address - Fax:937-981-1991
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1539111N00000X
MO005741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9355461OtherMEDICARE ID- GROUP NUMBER: GREENFIELD CHIROPRACTIC
OH000000475900OtherANTHEM BC/BS
OH000000475900OtherANTHEM BC/BS
OHMC0685755Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
OH9333581Medicare ID - Type UnspecifiedGROUP NUMBER