Provider Demographics
NPI:1790490803
Name:RENEW CHIROPRACTIC AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:RENEW CHIROPRACTIC AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANNER
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-328-8538
Mailing Address - Street 1:4825 EP TRUE PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-6403
Mailing Address - Country:US
Mailing Address - Phone:515-328-8538
Mailing Address - Fax:
Practice Address - Street 1:4825 EP TRUE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-6403
Practice Address - Country:US
Practice Address - Phone:515-328-8538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty