Provider Demographics
NPI:1619684453
Name:RENEW CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:RENEW CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-456-7843
Mailing Address - Street 1:715 S COY RD STE C
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3010
Mailing Address - Country:US
Mailing Address - Phone:419-567-8438
Mailing Address - Fax:
Practice Address - Street 1:715 S COY RD STE C
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3010
Practice Address - Country:US
Practice Address - Phone:419-567-8438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty