Provider Demographics
NPI:1508933326
Name:RENAUD, FREDRICK NORMAN (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:NORMAN
Last Name:RENAUD
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 1:2637 JENSEN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-9799
Mailing Address - Country:US
Mailing Address - Phone:559-875-4000
Mailing Address - Fax:559-875-4978
Practice Address - Street 1:2637 JENSEN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-9799
Practice Address - Country:US
Practice Address - Phone:559-875-4000
Practice Address - Fax:559-875-4978
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0236870Medicare ID - Type Unspecified