MEDICARE: RENEE AMY FAY D.C.

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	111N00000X	Chiropractor	2301010070	MI

General Provider Information

NPI Number	:	1689913618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE AMY FAY D.C.

Provider Business Mailing Address
First Line	:	11542 BOWENS MILL RD
Second Line	:
City	:	MIDDLEVILLE
State	:	MI
Zip	:	49333-9761
Country	:	US
Telephone Number	:	989-415-0465
Fax Number	:

Provider Business Practice Location Address
First Line	:	5164 LAKE MICHIGAN DR STE D
Second Line	:
City	:	ALLENDALE
State	:	MI
Zip	:	49401-8506
Country	:	US
Telephone Number	:	616-777-0309
Fax Number	:

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

Provider Enumeration Date	:	02/12/2013
Last Update Date	:	10/10/2018

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