Healthcare Provider Details

I. General information

NPI: 1992922934
Provider Name (Legal Business Name): RENALD ALEXANDER TROTTIER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RON TROTTIER D.C.

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 605
CHICAGO IL
60602-3806
US

IV. Provider business mailing address

6480 CHEROKEE DR
INDIAN HEAD PARK IL
60525-4321
US

V. Phone/Fax

Practice location:
  • Phone: 312-422-0042
  • Fax: 312-269-5559
Mailing address:
  • Phone: 312-437-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number038-007857
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: