Provider Demographics
NPI:1881732014
Name:REYNOLDS, DALE EUGENE (DC)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:EUGENE
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 1:920 PLANTATION RD
Mailing Address - Street 2:STE 104
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-3835
Mailing Address - Country:US
Mailing Address - Phone:540-951-1183
Mailing Address - Fax:540-951-1138
Practice Address - Street 1:920 PLANTATION RD
Practice Address - Street 2:STE 104
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-3835
Practice Address - Country:US
Practice Address - Phone:540-951-1183
Practice Address - Fax:540-951-1138
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U51627Medicare UPIN