Provider Demographics
NPI:1083826523
Name:RENFROE SPINAL CENTER LLC
Entity Type:Organization
Organization Name:RENFROE SPINAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RENFROE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-474-8688
Mailing Address - Street 1:8201 UNIVERSITY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514
Mailing Address - Country:US
Mailing Address - Phone:850-474-8688
Mailing Address - Fax:850-969-2910
Practice Address - Street 1:1421 EAST NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514
Practice Address - Country:US
Practice Address - Phone:850-484-7735
Practice Address - Fax:850-484-7736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC629Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FL70974YMedicare PIN