Provider Demographics
NPI:1427025972
Name:RENSLOW, BRETT RICHARD (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:RICHARD
Last Name:RENSLOW
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2883 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE #102
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3662
Mailing Address - Country:US
Mailing Address - Phone:954-217-0234
Mailing Address - Fax:
Practice Address - Street 1:2883 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE #102
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3662
Practice Address - Country:US
Practice Address - Phone:954-217-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD393ZMedicare PIN