MEDICARE: RENEW SPINE & WELLNESS CHIROPRACTIC CENTERS, 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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1609687607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEW SPINE & WELLNESS CHIROPRACTIC CENTERS, LLC

Provider Business Mailing Address
First Line	:	1520 W CHURCH ST
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-1532
Country	:	US
Telephone Number	:	419-302-4863
Fax Number	:	740-522-5500

Provider Business Practice Location Address
First Line	:	1520 W CHURCH ST
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-1532
Country	:	US
Telephone Number	:	740-670-0890
Fax Number	:	740-670-0889

Authorized Official
Title or Position	:	OWNER
Name	:	CODY D MCCLINTOCK
Credential	:
Telephone Number	:	419-302-4863

Provider Enumeration Date	:	01/17/2025
Last Update Date	:	02/18/2026

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