1972540243 NPI number — ANGELA R. RENNER, D.C., P.A.

Table of content: (NPI 1972540243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972540243 NPI number — ANGELA R. RENNER, D.C., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELA R. RENNER, D.C., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTHLAND CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972540243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
603 8TH ST N
Provider Second Line Business Mailing Address:
PO BOX 1014
Provider Business Mailing Address City Name:
VIRGINIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55792-2331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-741-1888
Provider Business Mailing Address Fax Number:
218-741-4888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 8TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55792-2331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-741-1888
Provider Business Practice Location Address Fax Number:
218-741-4888
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RENNER
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
RENE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
218-741-1888

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4701 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 221092400 . This is a "MHCP PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 276P6RE . This is a "PARTICIPATING BCBS PROV #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com