Provider Demographics
NPI:1699391417
Name:RIGBY LAKE CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:RIGBY LAKE CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RENEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-745-5165
Mailing Address - Street 1:711 RIGBY LAKE DR STE 1102
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5372
Mailing Address - Country:US
Mailing Address - Phone:208-745-5165
Mailing Address - Fax:
Practice Address - Street 1:711 RIGBY LAKE DR STE 1102
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5372
Practice Address - Country:US
Practice Address - Phone:208-745-5165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty