Provider Demographics
NPI:1821018037
Name:RENK, MICHAEL REGIS (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:REGIS
Last Name:RENK
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 1:9125 MARSHALL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-3603
Mailing Address - Country:US
Mailing Address - Phone:724-779-9600
Mailing Address - Fax:724-779-9610
Practice Address - Street 1:9125 MARSHALL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-3603
Practice Address - Country:US
Practice Address - Phone:724-779-9600
Practice Address - Fax:724-779-9610
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007340L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1586268OtherBLUE CROSS BLUE SHIELD
PA071765Medicare ID - Type UnspecifiedCHIROPRACTIC