Provider Demographics
NPI:1982313540
Name:RENKEN, DYLAN (DC)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:RENKEN
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 1:19939 CHASEWOOD PARK DR APT 3304
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1594
Mailing Address - Country:US
Mailing Address - Phone:217-414-9405
Mailing Address - Fax:
Practice Address - Street 1:21212 KUYKENDAHL RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-2605
Practice Address - Country:US
Practice Address - Phone:832-558-8979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor