Provider Demographics
NPI:1326122623
Name:RENAUD, TIFFANY (DC)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:RENAUD
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 1:3000 WILLISTON RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6082
Mailing Address - Country:US
Mailing Address - Phone:802-658-6092
Mailing Address - Fax:802-863-9565
Practice Address - Street 1:3000 WILLISTON RD
Practice Address - Street 2:SUITE 3
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6082
Practice Address - Country:US
Practice Address - Phone:802-658-6092
Practice Address - Fax:802-863-9565
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0000905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00018436OtherBLUE CROSS/BLUE SHIELD
VT00018436OtherBLUE CROSS/BLUE SHIELD
VTU29453Medicare UPIN