MEDICARE: DR. GREGORY WAYNE RENEAU DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	273422	OR

General Provider Information

NPI Number	:	1649396631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY WAYNE RENEAU DC

Provider Business Mailing Address
First Line	:	1632 NW HUGHWOOD CT
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-8881
Country	:	US
Telephone Number	:	541-677-9199
Fax Number	:	541-672-4326

Provider Business Practice Location Address
First Line	:	780 NW GARDEN VALLEY BLVD
Second Line	:	SUITE #300
City	:	ROSEBURG
State	:	OR
Zip	:	97470-1955
Country	:	US
Telephone Number	:	541-677-9199
Fax Number	:	541-672-4326

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/16/2017

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