Provider Demographics
NPI:1902914989
Name:RENEGAR, DELILAH ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:DELILAH
Middle Name:ANN
Last Name:RENEGAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 N RIVER RD STE 114
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8947
Mailing Address - Country:US
Mailing Address - Phone:630-479-9355
Mailing Address - Fax:630-566-1633
Practice Address - Street 1:640 N RIVER RD STE 114
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-479-9355
Practice Address - Fax:630-566-1633
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006687111NI0900X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25255Medicare ID - Type Unspecified
ILU19760Medicare UPIN