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General NPI Number Information
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NPI Number | 1619684453
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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 | 11/01/2022
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Last Update Date | 04/22/2023
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Provider Practice Location Address
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Address Line | 715 S COY RD STE C
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City | OREGON
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State | OH
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Zip | 43616-3010
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Country | US
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Telephone | 419-567-8438
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Fax |
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Provider Business Mailing Address
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Address Line | 715 S COY RD STE C
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City | OREGON
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State | OH
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Zip | 43616-3010
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Country | US
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Telephone | 419-567-8438
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. JAMIE MAHANEY
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Credential | DC
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Telephone | 419-456-7843
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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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