Provider Demographics
NPI:1174037071
Name:RELEASE AND RESTORE WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:RELEASE AND RESTORE WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPENBROCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-730-0970
Mailing Address - Street 1:3345 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-1381
Mailing Address - Country:US
Mailing Address - Phone:315-730-0970
Mailing Address - Fax:
Practice Address - Street 1:3345 PENN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15201-1381
Practice Address - Country:US
Practice Address - Phone:315-730-0970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty