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General NPI Number Information
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NPI Number | 1578501482
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Entity Type | Individual
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Provider Name | ANGELA RENE RENNER D.C.
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Gender | Female
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 12/29/2008
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Provider Practice Location Address
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Address Line | 603 8TH ST N
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City | VIRGINIA
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State | MN
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Zip | 55792-2331
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Country | US
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Telephone | 218-741-1888
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Fax | 218-741-4888
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Provider Business Mailing Address
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Address Line | 603 8TH ST N PO BOX 1014
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City | VIRGINIA
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State | MN
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Zip | 55792-2331
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Country | US
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Telephone | 218-741-1888
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Fax | 218-741-4888
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4701
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License Number State | MN
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