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General NPI Number Information
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NPI Number | 1215499397
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Entity Type | Organization
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Legal Business Name | RENEWED HEALTH FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 16645 W GREENFIELD AVE STE D
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City | NEW BERLIN
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State | WI
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Zip | 53151-1546
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Country | US
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Telephone | 262-788-5940
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Fax |
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Provider Business Mailing Address
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Address Line | N7004 COUNTY ROAD O
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City | ELKHORN
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State | WI
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Zip | 53121-2827
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Country | US
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Telephone | 262-903-1360
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | EMILY JOHANNA JOHNSON
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Credential | DC
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Telephone | 262-903-1360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0100X
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Taxonomy Name | Occupational Health Chiropractor
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License Number |
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License Number State |
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