Provider Demographics
NPI:1659914265
Name:R3NEW WELLNESS INC
Entity Type:Organization
Organization Name:R3NEW WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-903-5526
Mailing Address - Street 1:1145 E DOMINGUEZ ST STE G
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:855-447-5526
Practice Address - Street 1:1145 E DOMINGUEZ ST STE G
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3547
Practice Address - Country:US
Practice Address - Phone:714-398-7655
Practice Address - Fax:855-447-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-26
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty