Provider Demographics
NPI:1306021134
Name:RENEW CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:RENEW CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:JUMPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-493-5885
Mailing Address - Street 1:8015 W ALAMEDA AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3076
Mailing Address - Country:US
Mailing Address - Phone:720-493-5885
Mailing Address - Fax:720-493-8512
Practice Address - Street 1:8015 W ALAMEDA AVE STE 270
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3076
Practice Address - Country:US
Practice Address - Phone:720-493-5885
Practice Address - Fax:720-493-8512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC467658Medicare PIN