1851532949 NPI number — RENEWED HOPE CHIROPRACTIC, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851532949 NPI number — RENEWED HOPE CHIROPRACTIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENEWED HOPE CHIROPRACTIC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RENEWED HOPE CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851532949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1726 S WASHINGTON ST
Provider Second Line Business Mailing Address:
STE 79
Provider Business Mailing Address City Name:
GRAND FORKS
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58201-6370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-738-0990
Provider Business Mailing Address Fax Number:
701-738-0992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1726 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
STE 79
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201-6370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-738-0990
Provider Business Practice Location Address Fax Number:
701-738-0992
Provider Enumeration Date:
03/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SWENSON
Authorized Official First Name:
GARRET
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
701-738-0990

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  839 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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