Provider Demographics
NPI:1184948713
Name:CHIROPRACTIC RENEWAL
Entity type:Organization
Organization Name:CHIROPRACTIC RENEWAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECERTARY
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-530-0755
Mailing Address - Street 1:5130 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-530-0755
Mailing Address - Fax:954-530-0798
Practice Address - Street 1:5130 NORTH FEDERAL HIGHWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-530-0755
Practice Address - Fax:954-530-0798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty