Provider Demographics
NPI:1346208352
Name:RENO, MARK E (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:RENO
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 1:1610 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-3625
Mailing Address - Country:US
Mailing Address - Phone:316-524-5700
Mailing Address - Fax:316-524-0707
Practice Address - Street 1:1610 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211
Practice Address - Country:US
Practice Address - Phone:316-524-5700
Practice Address - Fax:316-524-0707
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060807OtherBLUE CROSS BLUE SHIELD
KS060807Medicare ID - Type Unspecified
KSU21740Medicare UPIN