Provider Demographics
NPI:1427829779
Name:RENZ, RYAN JOHN EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOHN EDWARD
Last Name:RENZ
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 1:5240 SW 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-3641
Mailing Address - Country:US
Mailing Address - Phone:208-651-0400
Mailing Address - Fax:
Practice Address - Street 1:10225 SW HALL BLVD STE 104
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8855
Practice Address - Country:US
Practice Address - Phone:503-208-3579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor