Individual provider Active NPI

David Charles Renner, D.C.

  • Chiropractor
  • Willowbrook, IL
National Provider Identifier
1043454549
Registry record updated Sep 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038.010876 Issued in IL
Practice address
16W501 Nielson LN
Willowbrook, IL 60527-6826
Phone
(630) 455-5885
NPI assigned
Apr 28, 2009
Last updated
Sep 16, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038.010876 IL Primary

Addresses

Primary practice location

16W501 Nielson LN
Willowbrook, IL 60527-6826

Mailing address

16W501 Nielson LN
Willowbrook, IL 60527-6826
Phone (630) 455-5885

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038.010876ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Hollies Essential Wellness LLC PastSince Sep 24, 2023 Accepting new patients
Back in Balance Chiropractic & Acupuncture Center, LTD. Chiropractor PastSince Dec 1, 2005 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253059200000",
    "number": "1043454549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16W501 NIELSON LN",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605276826",
            "telephone_number": "630-455-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16W501 NIELSON LN",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605276826",
            "telephone_number": "630-455-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENNER",
        "first_name": "DAVID",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-28",
        "last_updated": "2009-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.010876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willowbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.