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General NPI Number Information
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NPI Number | 1043324296
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Entity Type | Organization
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Legal Business Name | RENFRED R. HALVERSON DC., P.C.
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 1510 NEWCASTLE ST STE 200
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City | BRUNSWICK
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State | GA
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Zip | 31520-6825
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Country | US
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Telephone | 912-262-9735
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Fax | 912-262-9634
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Provider Business Mailing Address
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Address Line | 1510 NEWCASTLE ST STE 200
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City | BRUNSWICK
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State | GA
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Zip | 31520-6825
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Country | US
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Telephone | 912-262-9735
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Fax | 912-262-9634
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | REN R HALVERSON
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Credential | DC
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Telephone | 912-262-9735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIRO01742
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | GA1742
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License Number State | GA
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