Provider Demographics
NPI:1629779343
Name:RENEW CHIROPRACTIC AND FUNCTIONAL MEDICINE LLC
Entity Type:Organization
Organization Name:RENEW CHIROPRACTIC AND FUNCTIONAL MEDICINE LLC
Other - Org Name:RENEW CHIROPRACTIC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:SABRA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-717-7026
Mailing Address - Street 1:9151 CAENEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-3668
Mailing Address - Country:US
Mailing Address - Phone:316-737-8041
Mailing Address - Fax:
Practice Address - Street 1:9151 CAENEN LAKE RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3668
Practice Address - Country:US
Practice Address - Phone:316-737-8041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center