Provider Demographics
NPI:1467789891
Name:RENEW PHYSICIANS
Entity Type:Organization
Organization Name:RENEW PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAJIVE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ADLAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-864-9494
Mailing Address - Street 1:7284 W. LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-9526
Mailing Address - Country:US
Mailing Address - Phone:219-864-9494
Mailing Address - Fax:
Practice Address - Street 1:7284 W. LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-9526
Practice Address - Country:US
Practice Address - Phone:219-864-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002445A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty