Provider Demographics
NPI:1508347857
Name:RENEW WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:RENEW WELLNESS CENTER LLC
Other - Org Name:CIOTTI LASER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CIOTTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:228-327-7801
Mailing Address - Street 1:205 MONTGOMERY AVE BLDG 3
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-1500
Mailing Address - Country:US
Mailing Address - Phone:941-259-4544
Mailing Address - Fax:
Practice Address - Street 1:205 MONTGOMERY AVE BLDG 3
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-1500
Practice Address - Country:US
Practice Address - Phone:941-259-4544
Practice Address - Fax:941-822-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty