Provider Demographics
NPI:1366846644
Name:RENBARGER, GRAYSON (DC)
Entity Type:Individual
Prefix:DR
First Name:GRAYSON
Middle Name:
Last Name:RENBARGER
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 1:751 BLOSSOM HILL RD
Mailing Address - Street 2:SUITE # A2
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3583
Mailing Address - Country:US
Mailing Address - Phone:408-358-2689
Mailing Address - Fax:
Practice Address - Street 1:751 BLOSSOM HILL RD
Practice Address - Street 2:SUITE # A2
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3583
Practice Address - Country:US
Practice Address - Phone:408-358-2689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor