Provider Demographics
NPI:1881855898
Name:ROBERT C. RENDINA, D.C., APC
Entity Type:Organization
Organization Name:ROBERT C. RENDINA, D.C., APC
Other - Org Name:CHIRONETWORK CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:RENDINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:318-251-2243
Mailing Address - Street 1:103 W GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3846
Mailing Address - Country:US
Mailing Address - Phone:318-251-2243
Mailing Address - Fax:318-251-2266
Practice Address - Street 1:103 W GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3846
Practice Address - Country:US
Practice Address - Phone:318-251-2243
Practice Address - Fax:318-251-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA59158Medicare PIN