Provider Demographics
NPI:1184413742
Name:RENEWED HEALING CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:RENEWED HEALING CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-980-7471
Mailing Address - Street 1:6331 GREEN PINE DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9736
Mailing Address - Country:US
Mailing Address - Phone:248-980-7471
Mailing Address - Fax:
Practice Address - Street 1:7743 GRAND RIVER RD STE 106
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7393
Practice Address - Country:US
Practice Address - Phone:248-980-7471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty