MEDICARE: RENEW CHIROPRACTIC, 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	:	1619684453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEW CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	715 S COY RD STE C
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-3010
Country	:	US
Telephone Number	:	419-567-8438
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 S COY RD STE C
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-3010
Country	:	US
Telephone Number	:	419-567-8438
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN
Name	:	DR. JAMIE MAHANEY
Credential	:	DC
Telephone Number	:	419-456-7843

Provider Enumeration Date	:	11/01/2022
Last Update Date	:	04/22/2023

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