Provider Demographics
NPI:1316657398
Name:RENEW CHIROPRACTIC LLC
Entity type:Organization
Organization Name:RENEW CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STREET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-261-7502
Mailing Address - Street 1:201 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-4006
Mailing Address - Country:US
Mailing Address - Phone:563-506-3706
Mailing Address - Fax:
Practice Address - Street 1:201 E 2ND ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-4006
Practice Address - Country:US
Practice Address - Phone:563-506-3706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty