Provider Demographics
NPI:1467506675
Name:DR TODD C RENN, P.C.
Entity Type:Organization
Organization Name:DR TODD C RENN, P.C.
Other - Org Name:RAVENSWOOD CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:RENN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-878-7330
Mailing Address - Street 1:5215 N RAVENSWOOD AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1668
Mailing Address - Country:US
Mailing Address - Phone:773-878-7330
Mailing Address - Fax:773-878-2338
Practice Address - Street 1:5215 N RAVENSWOOD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1668
Practice Address - Country:US
Practice Address - Phone:773-878-7330
Practice Address - Fax:773-878-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty