Provider Demographics
NPI:1134302631
Name:FALLTRICK, DEAN RENNER (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:RENNER
Last Name:FALLTRICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5670 BELL RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-9261
Mailing Address - Country:US
Mailing Address - Phone:530-269-1128
Mailing Address - Fax:530-269-3414
Practice Address - Street 1:5670 BELL RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-9261
Practice Address - Country:US
Practice Address - Phone:530-269-1128
Practice Address - Fax:530-269-3414
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA016363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor