Provider Demographics
NPI:1295898898
Name:REYNOLDS, JAMES RUSSELL (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RUSSELL
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:33 PLYMOUTH STREET
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2677
Mailing Address - Country:US
Mailing Address - Phone:973-655-9800
Mailing Address - Fax:973-655-9813
Practice Address - Street 1:33 PLYMOUTH STREET
Practice Address - Street 2:SUITE LL1
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2677
Practice Address - Country:US
Practice Address - Phone:973-655-9800
Practice Address - Fax:973-655-9813
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ38MC00427700111N00000X
NYX0094791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ021355SOVMedicare ID - Type Unspecified