Provider Demographics
NPI:1780738013
Name:SPIEWAK, RENEE WHITING (DC)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:WHITING
Last Name:SPIEWAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:RENEE
Other - Middle Name:SUZANNE
Other - Last Name:WHITING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5015 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910
Mailing Address - Country:US
Mailing Address - Phone:517-394-5034
Mailing Address - Fax:517-394-5035
Practice Address - Street 1:5015 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910
Practice Address - Country:US
Practice Address - Phone:517-394-5034
Practice Address - Fax:517-394-5035
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI44-00023OtherPHP PROVIDER ID
MIP28260001Medicare ID - Type UnspecifiedPROVIDER ID
MIU78740Medicare UPIN