Provider Demographics
NPI:1992089486
Name:RENAISSANCE REHAB CLINIC LLC
Entity type:Organization
Organization Name:RENAISSANCE REHAB CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:956-263-1054
Mailing Address - Street 1:5322 E HWY 83 STE C-3
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-9426
Mailing Address - Country:US
Mailing Address - Phone:956-263-1054
Mailing Address - Fax:956-682-1829
Practice Address - Street 1:5322 E US HIGHWAY 83 STE 3C
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-9462
Practice Address - Country:US
Practice Address - Phone:956-263-1054
Practice Address - Fax:956-682-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty