Provider Demographics
NPI:1902335763
Name:ASPEN CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:ASPEN CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RENEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-802-1040
Mailing Address - Street 1:325 PARK HILL LN
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-9022
Mailing Address - Country:US
Mailing Address - Phone:541-802-1040
Mailing Address - Fax:541-802-1042
Practice Address - Street 1:325 PARK HILL LN
Practice Address - Street 2:
Practice Address - City:SUTHERLIN
Practice Address - State:OR
Practice Address - Zip Code:97479-9022
Practice Address - Country:US
Practice Address - Phone:541-802-1040
Practice Address - Fax:541-802-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
OR5535261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500663209Medicaid