Healthcare Provider Details

I. General information

NPI: 1902914989
Provider Name (Legal Business Name): DELILAH ANN RENEGAR D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4082 RIVER RDG
SANDWICH IL
60548-6905
US

IV. Provider business mailing address

4555 N LINCOLN AVE
CHICAGO IL
60625-2102
US

V. Phone/Fax

Practice location:
  • Phone: 630-479-9355
  • Fax: 815-786-7477
Mailing address:
  • Phone: 630-561-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number038-006687
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038-006687
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038006687
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: