Provider Demographics
NPI:1144909144
Name:RENAISSANCE SPINAL CARE AND REHAB LLC
Entity type:Organization
Organization Name:RENAISSANCE SPINAL CARE AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:CLAUDE
Authorized Official - Last Name:MICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-368-3402
Mailing Address - Street 1:2121 W OAKLAND PARK BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1507
Mailing Address - Country:US
Mailing Address - Phone:954-368-3402
Mailing Address - Fax:954-990-6199
Practice Address - Street 1:2121 W OAKLAND PARK BLVD STE 1
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1507
Practice Address - Country:US
Practice Address - Phone:954-368-3402
Practice Address - Fax:954-990-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty