Provider Demographics
NPI:1568123586
Name:RENGSTORF, MARSHALL (DC)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:
Last Name:RENGSTORF
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 1:3144 CHOWEN AVE S APT 405
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5454
Mailing Address - Country:US
Mailing Address - Phone:507-358-2804
Mailing Address - Fax:
Practice Address - Street 1:1630 101ST AVE NE STE 140
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-3401
Practice Address - Country:US
Practice Address - Phone:763-703-3509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-02
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor