Provider Demographics
NPI:1346564192
Name:DR RENEE M NOOMIE P C
Entity Type:Organization
Organization Name:DR RENEE M NOOMIE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NOOMIE
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:248-524-9100
Mailing Address - Street 1:1977 E WATTLES RD STE A
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-5047
Mailing Address - Country:US
Mailing Address - Phone:248-524-9100
Mailing Address - Fax:248-524-0614
Practice Address - Street 1:1977 E WATTLES RD STE A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-5047
Practice Address - Country:US
Practice Address - Phone:248-524-9100
Practice Address - Fax:248-524-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F35308Medicare PIN