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General NPI Number Information
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NPI Number | 1659668309
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Entity Type | Organization
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Legal Business Name | DR. BRETT RENQUIST D.C., L.AC
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 1095 LIBERTY ST SE
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City | SALEM
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State | OR
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Zip | 97302-4140
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Country | US
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Telephone | 503-585-1282
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Fax | 503-585-5531
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Provider Business Mailing Address
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Address Line | 1095 LIBERTY ST SE
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City | SALEM
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State | OR
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Zip | 97302-4140
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Country | US
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Telephone | 503-585-1282
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Fax | 503-585-5531
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Authorized Official
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Title or Position | CHIROPRACTOR, ACUPUNCTURIST
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Name | DR. BRETT RENQUIST
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Credential | D.C., L.AC
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Telephone | 503-585-1282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC153703
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License Number State | OR
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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 | 4042
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License Number State | OR
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