Provider Demographics
NPI:1578501482
Name:RENNER, ANGELA RENE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:RENE
Last Name:RENNER
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 1:603 8TH ST N
Mailing Address - Street 2:PO BOX 1014
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2331
Mailing Address - Country:US
Mailing Address - Phone:218-741-1888
Mailing Address - Fax:218-741-4888
Practice Address - Street 1:603 8TH ST N
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2331
Practice Address - Country:US
Practice Address - Phone:218-741-1888
Practice Address - Fax:218-741-4888
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN276P6REOtherBCBS OF MN INDIV. PROV. #
MN221092400OtherMHCP PROVIDER NUMBER
MN350003482Medicare ID - Type Unspecified
MNV07041Medicare UPIN