Healthcare Provider Details

I. General information

NPI: 1619976743
Provider Name (Legal Business Name): STEPHEN RENICK JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2658 MAGUIRE RD
OCOEE FL
34761-4752
US

IV. Provider business mailing address

2658 MAGUIRE RD
OCOEE FL
34761-4752
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-2400
  • Fax: 407-877-0958
Mailing address:
  • Phone: 407-877-2400
  • Fax: 407-877-0958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberX2538
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH9701
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: