Provider Demographics
NPI:1508875378
Name:RENNE, CHRISTOPHER BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BRIAN
Last Name:RENNE
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 1:4111 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-2038
Mailing Address - Country:US
Mailing Address - Phone:904-398-4860
Mailing Address - Fax:904-398-1785
Practice Address - Street 1:4111 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-2038
Practice Address - Country:US
Practice Address - Phone:904-398-4860
Practice Address - Fax:904-398-1785
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262820382Medicaid