Provider Demographics
NPI:1477259778
Name:RENOVO CHIROPRACTIC AND WELLNESS, LLC
Entity Type:Organization
Organization Name:RENOVO CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-335-6333
Mailing Address - Street 1:914 D ST NE STE 101
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4163
Mailing Address - Country:US
Mailing Address - Phone:253-939-0906
Mailing Address - Fax:253-939-3381
Practice Address - Street 1:914 D ST NE STE 101
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4163
Practice Address - Country:US
Practice Address - Phone:253-939-0906
Practice Address - Fax:253-939-3381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1992197701OtherNPI