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General NPI Number Information
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NPI Number | 1316657398
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Entity Type | Organization
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Legal Business Name | RENEW CHIROPRACTIC LLC
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 201 E 2ND ST
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City | MUSCATINE
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State | IA
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Zip | 52761-4006
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Country | US
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Telephone | 563-506-3706
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Fax |
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Provider Business Mailing Address
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Address Line | 201 E 2ND ST
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City | MUSCATINE
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State | IA
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Zip | 52761-4006
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Country | US
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Telephone | 563-506-3706
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOSIAH STREET
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Credential | DC
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Telephone | 563-261-7502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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