Provider Demographics
NPI:1689913618
Name:FAY, RENEE AMY (DC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:AMY
Last Name:FAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:MAURER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:11542 BOWENS MILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-9761
Mailing Address - Country:US
Mailing Address - Phone:989-415-0465
Mailing Address - Fax:
Practice Address - Street 1:5164 LAKE MICHIGAN DR STE D
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8506
Practice Address - Country:US
Practice Address - Phone:616-777-0309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor