Provider Demographics
NPI:1376394650
Name:RENOUF, REAGAN NICOLE (DC)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:NICOLE
Last Name:RENOUF
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 1:2130 CLOUD LINE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-3036
Mailing Address - Country:US
Mailing Address - Phone:512-431-1967
Mailing Address - Fax:
Practice Address - Street 1:4540 W BAILEY BOSWELL RD STE 170
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-4439
Practice Address - Country:US
Practice Address - Phone:817-497-8961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor