Provider Demographics
NPI:1700908977
Name:RENGERT, MICHAEL WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:RENGERT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5118 S COUNTY ROAD 300 E
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:IN
Mailing Address - Zip Code:47353-9334
Mailing Address - Country:US
Mailing Address - Phone:765-732-3090
Mailing Address - Fax:
Practice Address - Street 1:4434 CARVER WOODS DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5531
Practice Address - Country:US
Practice Address - Phone:513-489-9515
Practice Address - Fax:513-489-8350
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor