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General NPI Number Information
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NPI Number | 1134642762
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Entity Type | Organization
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Legal Business Name | LOS GATOS FAMILY CHIROPRACTIC RENBARGER INC
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 02/14/2019
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Provider Practice Location Address
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Address Line | 751 BLOSSOM HILL RD STE A1
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City | LOS GATOS
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State | CA
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Zip | 95032-3583
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Country | US
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Telephone | 408-358-8180
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Fax | 408-356-8214
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Provider Business Mailing Address
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Address Line | 751 BLOSSOM HILL RD STE A1
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City | LOS GATOS
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State | CA
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Zip | 95032-3583
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Country | US
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Telephone | 408-358-8180
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Fax |
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | DR. GRAYSON WILLIAM RENBARGER
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Credential | DC
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Telephone | 408-358-8180
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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 | DC33065
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License Number State | CA
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