Healthcare Provider Details

I. General information

NPI: 1326122623
Provider Name (Legal Business Name): TIFFANY RENAUD D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 WILLISTON RD SUITE 3
SOUTH BURLINGTON VT
05403-6082
US

IV. Provider business mailing address

3000 WILLISTON RD SUITE 3
SOUTH BURLINGTON VT
05403-6082
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-6092
  • Fax: 802-863-9565
Mailing address:
  • Phone: 802-658-6092
  • Fax: 802-863-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006-0000905
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: