Provider Demographics
NPI:1043328651
Name:RENYO, JOHN CLIFFORD (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CLIFFORD
Last Name:RENYO
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 1:23684 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-3228
Mailing Address - Country:US
Mailing Address - Phone:717-805-9410
Mailing Address - Fax:
Practice Address - Street 1:509 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-2917
Practice Address - Country:US
Practice Address - Phone:302-422-3100
Practice Address - Fax:302-422-2900
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0001022111N00000X
PADC003410-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA011046360003Medicaid
PA507-603Medicare ID - Type Unspecified
PA011046360003Medicaid