Provider Demographics
NPI:1881850832
Name:RENZE CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:RENZE CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RENZE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DIBCN
Authorized Official - Phone:515-965-3844
Mailing Address - Street 1:925 E 1ST ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-2169
Mailing Address - Country:US
Mailing Address - Phone:515-965-3844
Mailing Address - Fax:515-965-3829
Practice Address - Street 1:925 E 1ST ST
Practice Address - Street 2:SUITE L
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2169
Practice Address - Country:US
Practice Address - Phone:515-965-3844
Practice Address - Fax:515-965-3829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06501111N00000X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0726679Medicaid
IA1267773Medicaid
IA1267773Medicaid
IAU89995Medicare UPIN