Provider Demographics
NPI:1679674980
Name:REYNOLDS, CYNTHIA ANNE (DC)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANNE
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 1:1906 KNOB CREEK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3097
Mailing Address - Country:US
Mailing Address - Phone:423-282-5223
Mailing Address - Fax:423-282-4479
Practice Address - Street 1:1906 KNOB CREEK RD STE 1
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3097
Practice Address - Country:US
Practice Address - Phone:423-282-5223
Practice Address - Fax:423-282-4479
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6565607OtherCIGNA
TN0107174OtherBC/BS
TNT74811Medicare UPIN
TN0107174OtherBC/BS