Kristine M Renn, DC
Individual provider Active NPI Chiropractor · Oglesby, IL
NPI 1720157670 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720157670
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- Practice address
- 502 Swift Ave
Oglesby, IL 61348-1172 - Phone
- (815) 883-7024
- NPI assigned
- Nov 7, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038 008805 | IL | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | IL | Yes |
Addresses
Primary practice location
502 Swift Ave
Oglesby, IL 61348-1172
Mailing address
502 Swift Ave
Oglesby, IL 61348-1172
Phone (815) 883-7024
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05022845 | Other | BLUE CROSS |
Other providers in Oglesby, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.