Provider Demographics
NPI:1114249729
Name:RENEWED LIFE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:RENEWED LIFE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MONTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-687-6604
Mailing Address - Street 1:156 HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-4081
Mailing Address - Country:US
Mailing Address - Phone:913-837-3310
Mailing Address - Fax:913-440-0511
Practice Address - Street 1:156 HARVEST DR
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053-4081
Practice Address - Country:US
Practice Address - Phone:913-837-3310
Practice Address - Fax:913-440-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty