Provider Demographics
NPI:1811974173
Name:REYNOLDS, CAROL L (DC)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:L
Last Name:REYNOLDS
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 1:2850 BELLA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-3708
Mailing Address - Country:US
Mailing Address - Phone:479-855-3553
Mailing Address - Fax:479-855-7618
Practice Address - Street 1:2850 BELLA VISTA WAY
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-3708
Practice Address - Country:US
Practice Address - Phone:479-855-3553
Practice Address - Fax:479-855-7618
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1376111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S891Medicare ID - Type Unspecified
U52844Medicare UPIN
ARU52844Medicare PIN