Provider Demographics
NPI:1881307908
Name:RENFROE, REILY (DC)
Entity type:Individual
Prefix:DR
First Name:REILY
Middle Name:
Last Name:RENFROE
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 1:310 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-7449
Mailing Address - Country:US
Mailing Address - Phone:469-810-3002
Mailing Address - Fax:
Practice Address - Street 1:310 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-7449
Practice Address - Country:US
Practice Address - Phone:469-810-3002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor