Healthcare Provider Details

I. General information

NPI: 1841333473
Provider Name (Legal Business Name): DR. PETER-JOHN FRANK RENNIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PETER RENNIE D.C.

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 E SHEA BLVD 103
SCOTTSDALE AZ
85260-6635
US

IV. Provider business mailing address

8402 E SHEA BLVD 103
SCOTTSDALE AZ
85260-6635
US

V. Phone/Fax

Practice location:
  • Phone: 480-236-5166
  • Fax: 480-451-3500
Mailing address:
  • Phone: 480-236-5166
  • Fax: 480-451-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number8018
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number1883
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: