Provider Demographics
NPI:1437498375
Name:RICHARD RENEAU CHIROPRACTIC PC
Entity Type:Organization
Organization Name:RICHARD RENEAU CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:RENEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-677-9199
Mailing Address - Street 1:1632 NW HUGHWOOD CT
Mailing Address - Street 2:STE 1
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8881
Mailing Address - Country:US
Mailing Address - Phone:541-677-9199
Mailing Address - Fax:541-672-4326
Practice Address - Street 1:1632 NW HUGHWOOD CT
Practice Address - Street 2:STE 1
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8881
Practice Address - Country:US
Practice Address - Phone:541-677-9199
Practice Address - Fax:541-672-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty