Active NPI
Reagan Nicole Renouf, DC
- Chiropractor
- Southlake, TX
National Provider Identifier
1376394650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 15973
- Practice address
- 1161 E Southlake Blvd Ste 210
Southlake, TX 76092-6575 - Phone
- (817) 497-8216
- NPI assigned
- Mar 27, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 15973 | TX | Primary |
Addresses
Primary practice location
1161 E Southlake Blvd Ste 210
Southlake, TX 76092-6575
Mailing address
1161 E Southlake Blvd Ste 210
Southlake, TX 76092-6575
Phone (512) 431-1967
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15973 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727222400000",
"number": "1376394650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1161 E SOUTHLAKE BLVD STE 210",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "760926575",
"telephone_number": "512-431-1967"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1161 E SOUTHLAKE BLVD STE 210",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "760926575",
"telephone_number": "817-497-8216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENOUF",
"first_name": "REAGAN",
"middle_name": "NICOLE",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-03-27",
"last_updated": "2024-09-25",
"certification_date": "2024-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "TX",
"license": "15973",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southlake, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.