Provider Demographics
NPI:1134642762
Name:LOS GATOS FAMILY CHIROPRACTIC RENBARGER INC
Entity Type:Organization
Organization Name:LOS GATOS FAMILY CHIROPRACTIC RENBARGER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAYSON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:RENBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-358-8180
Mailing Address - Street 1:751 BLOSSOM HILL RD STE A1
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3583
Mailing Address - Country:US
Mailing Address - Phone:408-358-8180
Mailing Address - Fax:
Practice Address - Street 1:751 BLOSSOM HILL RD STE A1
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3583
Practice Address - Country:US
Practice Address - Phone:408-358-8180
Practice Address - Fax:408-356-8214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC33065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty