MEDICARE: RENOVO CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710442751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENOVO CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	PO BOX 1235
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-8135
Country	:	US
Telephone Number	:	541-961-8116
Fax Number	:

Provider Business Practice Location Address
First Line	:	2147 NW HIGHWAY 101
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-4254
Country	:	US
Telephone Number	:	541-961-8116
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL ANGEL NELSON
Credential	:	DC
Telephone Number	:	541-961-8116

Provider Enumeration Date	:	02/04/2019
Last Update Date	:	04/29/2019

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Directions to “RENOVO CHIROPRACTIC LLC ” Practice Location

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