Provider Demographics
NPI:1649396631
Name:RENEAU, GREGORY WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WAYNE
Last Name:RENEAU
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 1:1632 NW HUGHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8881
Mailing Address - Country:US
Mailing Address - Phone:541-677-9199
Mailing Address - Fax:541-672-4326
Practice Address - Street 1:780 NW GARDEN VALLEY BLVD
Practice Address - Street 2:SUITE #300
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1955
Practice Address - Country:US
Practice Address - Phone:541-677-9199
Practice Address - Fax:541-672-4326
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273422111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR133722Medicare ID - Type Unspecified