Provider Demographics
NPI:1841333473
Name:RENNIE, PETER-JOHN FRANK
Entity type:Individual
Prefix:DR
First Name:PETER-JOHN
Middle Name:FRANK
Last Name:RENNIE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:RENNIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:8402 E SHEA BLVD
Mailing Address - Street 2:103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6635
Mailing Address - Country:US
Mailing Address - Phone:480-236-5166
Mailing Address - Fax:480-451-3500
Practice Address - Street 1:8402 E SHEA BLVD
Practice Address - Street 2:103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6635
Practice Address - Country:US
Practice Address - Phone:480-236-5166
Practice Address - Fax:480-451-3500
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8018111NR0400X
1883246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic