Provider Demographics
NPI:1821229337
Name:ANDERSON, REGINALD M (DC)
Entity type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:M
Last Name:ANDERSON
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:PO BOX 3272
Mailing Address - Street 2:835 S 7TH ST, LOUISVILLE
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-3272
Mailing Address - Country:US
Mailing Address - Phone:502-365-2569
Mailing Address - Fax:502-365-2640
Practice Address - Street 1:1126 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2902
Practice Address - Country:US
Practice Address - Phone:502-365-2569
Practice Address - Fax:502-365-2640
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008488111N00000X
KY5226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor