Provider Demographics
NPI:1821150772
Name:RENN CHIROPRACTIC PS
Entity Type:Organization
Organization Name:RENN CHIROPRACTIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:G
Authorized Official - Last Name:RENN
Authorized Official - Suffix:
Authorized Official - Credentials:DC PRESIDENT OF CORP
Authorized Official - Phone:253-539-3854
Mailing Address - Street 1:10919 CANYON ROAD E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373
Mailing Address - Country:US
Mailing Address - Phone:253-539-3854
Mailing Address - Fax:253-539-3864
Practice Address - Street 1:10919 CANYON ROAD E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373
Practice Address - Country:US
Practice Address - Phone:253-539-3854
Practice Address - Fax:253-539-3864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty