Healthcare Provider Details

I. General information

NPI: 1902335763
Provider Name (Legal Business Name): ASPEN CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 07/21/2022
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 PARK HILL LN
SUTHERLIN OR
97479-9022
US

IV. Provider business mailing address

325 PARK HILL LN
SUTHERLIN OR
97479-9022
US

V. Phone/Fax

Practice location:
  • Phone: 541-802-1040
  • Fax: 541-802-1042
Mailing address:
  • Phone: 541-802-1040
  • Fax: 541-802-1042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number5535
License Number StateOR

VIII. Authorized Official

Name: DR. CHRISTOPHER RENEAU
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 541-802-1040