Healthcare Provider Details

I. General information

NPI: 1295400968
Provider Name (Legal Business Name): ROBERT M RENKIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2574 APPIAN WAY
PINOLE CA
94564-2237
US

IV. Provider business mailing address

2574 APPIAN WAY
PINOLE CA
94564-2237
US

V. Phone/Fax

Practice location:
  • Phone: 510-243-2425
  • Fax: 510-243-2428
Mailing address:
  • Phone: 510-243-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC36151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: