Provider Demographics
NPI:1508057704
Name:RENCHER, ELLEN A (DC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:A
Last Name:RENCHER
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 1:985 UNIVERSITY AVE
Mailing Address - Street 2:STE. 36
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-7639
Mailing Address - Country:US
Mailing Address - Phone:408-399-5678
Mailing Address - Fax:408-399-4655
Practice Address - Street 1:985 UNIVERSITY AVE
Practice Address - Street 2:STE. 36
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-7639
Practice Address - Country:US
Practice Address - Phone:408-399-5678
Practice Address - Fax:408-399-4655
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA24570DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor