Provider Demographics
NPI:1043324296
Name:RENFRED R. HALVERSON DC., P.C.
Entity type:Organization
Organization Name:RENFRED R. HALVERSON DC., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HALVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-262-9735
Mailing Address - Street 1:1510 NEWCASTLE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-6825
Mailing Address - Country:US
Mailing Address - Phone:912-262-9735
Mailing Address - Fax:912-262-9634
Practice Address - Street 1:1510 NEWCASTLE ST STE 200
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-6825
Practice Address - Country:US
Practice Address - Phone:912-262-9735
Practice Address - Fax:912-262-9634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO01742111N00000X
GAGA1742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1043324296OtherGROUP NPI NUMBER
GAGRP7792OtherPTAN #
GAT97622Medicare UPIN
GAGRP7792OtherPTAN #