Provider Demographics
NPI:1477892628
Name:RENEAU, RICHARD (DC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:RENEAU
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 1:325 PARK HILL LN
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-9022
Mailing Address - Country:US
Mailing Address - Phone:541-802-1040
Mailing Address - Fax:541-802-1042
Practice Address - Street 1:1632 NW HUGHWOOD CT
Practice Address - Street 2:STE 1
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8881
Practice Address - Country:US
Practice Address - Phone:541-677-9199
Practice Address - Fax:541-672-4326
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor