Provider Demographics
NPI:1912073180
Name:RENNER, STEPHEN FRANK (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FRANK
Last Name:RENNER
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 1:2721 E SPRAGUE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202
Mailing Address - Country:US
Mailing Address - Phone:509-535-3038
Mailing Address - Fax:509-535-9749
Practice Address - Street 1:2721 E SPRAGUE AVENUE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-535-3038
Practice Address - Fax:509-535-9749
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA236270Medicaid
T02381Medicare UPIN
WAAB37964Medicare ID - Type Unspecified