Provider Demographics
NPI:1760605646
Name:CHIROPRACTIC ASSOCIATES OF CRANBERRY, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC ASSOCIATES OF CRANBERRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:REGIS
Authorized Official - Last Name:RENK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-779-9600
Mailing Address - Street 1:9125 MARSHALL ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066
Mailing Address - Country:US
Mailing Address - Phone:724-779-9600
Mailing Address - Fax:724-779-9610
Practice Address - Street 1:9125 MARSHALL ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066
Practice Address - Country:US
Practice Address - Phone:724-779-9600
Practice Address - Fax:724-779-9610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007340L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA071765Medicare ID - Type Unspecified