Provider Demographics
NPI:1508490244
Name:RENEWED BODY CHIROPRACTIC & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:RENEWED BODY CHIROPRACTIC & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-509-5846
Mailing Address - Street 1:125 N HALSTED ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2160
Mailing Address - Country:US
Mailing Address - Phone:312-285-2116
Mailing Address - Fax:
Practice Address - Street 1:125 N HALSTED ST STE 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2160
Practice Address - Country:US
Practice Address - Phone:312-285-2116
Practice Address - Fax:312-285-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty