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General NPI Number Information
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NPI Number | 1992922934
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Entity Type | Individual
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Provider Name | RENALD ALEXANDER TROTTIER D.C.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE STE 605
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City | CHICAGO
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State | IL
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Zip | 60602-3806
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Country | US
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Telephone | 312-422-0042
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Fax | 312-269-5559
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Provider Business Mailing Address
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Address Line | 6480 CHEROKEE DR
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City | INDIAN HEAD PARK
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State | IL
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Zip | 60525-4321
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Country | US
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Telephone | 312-437-9355
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Fax |
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 038-007857
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License Number State | IL
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