Provider Demographics
NPI:1164492815
Name:RENFROE, JOHN MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:RENFROE
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 1:1421 E NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5723
Mailing Address - Country:US
Mailing Address - Phone:850-484-7735
Mailing Address - Fax:850-484-7736
Practice Address - Street 1:1421 E NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5723
Practice Address - Country:US
Practice Address - Phone:850-484-7735
Practice Address - Fax:850-484-7736
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5606111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70974YMedicare PIN
FLT85543Medicare UPIN