Individual
MATTHEW WAYNE MCREYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
909 S GOLD AVE, DEMING, NM 88030-4754
(575) 546-5757
Mailing address
909 S GOLD AVE, DEMING, NM 88030-4754
(575) 546-5757
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1895
NM
111N00000X
Chiropractor
CHIA-1273
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NMAA1383
MEDICARE PTAN
NM
Enumeration date
09/24/2007
Last updated
10/03/2012
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