Provider Demographics
NPI:1972540243
Name:ANGELA R. RENNER, D.C., P.A.
Entity type:Organization
Organization Name:ANGELA R. RENNER, D.C., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:RENNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-741-1888
Mailing Address - Street 1:603 8TH ST N
Mailing Address - Street 2:PO BOX 1014
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2331
Mailing Address - Country:US
Mailing Address - Phone:218-741-1888
Mailing Address - Fax:218-741-4888
Practice Address - Street 1:603 8TH ST N
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2331
Practice Address - Country:US
Practice Address - Phone:218-741-1888
Practice Address - Fax:218-741-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN221092400OtherMHCP PROVIDER NUMBER
MN276P6REOtherPARTICIPATING BCBS PROV #
MNC04093Medicare ID - Type UnspecifiedGROUP NUMBER
MN276P6REOtherPARTICIPATING BCBS PROV #