1962876730 NPI number — RENEW CHIROPRACTIC & WELLNESS PA

Table of content: DR. JERREL BRAD MCANALLEY M.D. (NPI 1346341948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962876730 NPI number — RENEW CHIROPRACTIC & WELLNESS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENEW CHIROPRACTIC & WELLNESS PA
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:
Provider Other Organization Name Type Code:
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:
1962876730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1954 W STATE ROAD 426
Provider Second Line Business Mailing Address:
SUITE 1112
Provider Business Mailing Address City Name:
OVIEDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32765-8891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-287-6365
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1954 W STATE ROAD 426
Provider Second Line Business Practice Location Address:
SUITE 1112
Provider Business Practice Location Address City Name:
OVIEDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32765-8891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-287-6365
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LOIGNON
Authorized Official First Name:
SHERVIN
Authorized Official Middle Name:
VICTORIA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
407-287-6365

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH11704 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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