Provider Demographics
NPI:1407925902
Name:RENNINGER, THOMAS LEE (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEE
Last Name:RENNINGER
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 1:1258 112TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3712
Mailing Address - Country:US
Mailing Address - Phone:425-455-5566
Mailing Address - Fax:425-455-1305
Practice Address - Street 1:1258 112TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3712
Practice Address - Country:US
Practice Address - Phone:425-455-5566
Practice Address - Fax:425-455-1305
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911762485OtherTAX ID