Provider Demographics
NPI:1093776197
Name:TRENNER, RUTH (DC)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:TRENNER
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:PO BOX 1641
Mailing Address - Street 2:
Mailing Address - City:RAINIER
Mailing Address - State:OR
Mailing Address - Zip Code:97048-1641
Mailing Address - Country:US
Mailing Address - Phone:503-556-2353
Mailing Address - Fax:503-556-3065
Practice Address - Street 1:101 W 5TH ST
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:OR
Practice Address - Zip Code:97048-2634
Practice Address - Country:US
Practice Address - Phone:503-556-2353
Practice Address - Fax:503-556-3065
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR134502Medicare PIN
ORR134501Medicare PIN