Healthcare Provider Details

I. General information

NPI: 1477259778
Provider Name (Legal Business Name): RENOVO CHIROPRACTIC & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 09/03/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 D ST NE STE 101
AUBURN WA
98002-4163
US

IV. Provider business mailing address

914 D ST NE STE 101
AUBURN WA
98002-4163
US

V. Phone/Fax

Practice location:
  • Phone: 253-939-0906
  • Fax: 253-939-3381
Mailing address:
  • Phone: 253-939-0906
  • Fax: 253-939-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JESSICA BARENG-BARROS
Title or Position: PRESIDENT
Credential: DC
Phone: 253-939-0906