1134363351 NPI number — DR. GREGORY SHAUN REYNOLDS D.C.

Table of content: DR. GREGORY SHAUN REYNOLDS D.C. (NPI 1134363351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134363351 NPI number — DR. GREGORY SHAUN REYNOLDS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYNOLDS
Provider First Name:
GREGORY
Provider Middle Name:
SHAUN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REYNOLDS
Provider Other First Name:
G. SHAUN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1134363351
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3415 BEAR RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH JORDAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84095-5002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-810-4144
Provider Business Mailing Address Fax Number:
801-523-2547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
826 E 12300 S STE 4B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRAPER
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84020-8276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-810-4144
Provider Business Practice Location Address Fax Number:
801-523-2547
Provider Enumeration Date:
05/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  7234463-1202 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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