NPIMap

Organization Active NPI

Renovation Chiropractic, Inc.

  • Chiropractor
  • Warner Robins, GA
National Provider Identifier
1184048092
Registry record updated May 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIRO009223 Issued in GA
Legal business name
RENOVATION CHIROPRACTIC, INC.
Practice address
3035 Watson Blvd
Suite 5
Warner Robins, GA 31093-9526
Phone
(770) 982-4886
Fax
(770) 979-2275
NPI assigned
Feb 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Jeremy Pettygrove, DCNPI 1851715767
Title
Provider/President
Phone
(478) 334-7958

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X CHIRO009223 GA Primary

Addresses

Primary practice location

3035 Watson Blvd
Suite 5
Warner Robins, GA 31093-9526

Mailing address

3035 Watson Blvd
Suite 5
Warner Robins, GA 31093-9526
Phone (770) 982-4886

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140505000907 GA Part B Supplier - Clinic/Group Practice 1951534668 Receives reassigned benefits from 2 practitioners
Practice locations: Macon, GA; Warner Robins, GA

National Provider Directory

National Provider Directory

Locations

3035 Watson Blvd
Ste 5
Warner Robins, GA 31093
Phone (478) 333-6134

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1392163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399248000000",
    "number": "1184048092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3035 WATSON BLVD",
            "address_2": "SUITE 5",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310939526",
            "telephone_number": "770-982-4886",
            "fax_number": "770-979-2275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3035 WATSON BLVD",
            "address_2": "SUITE 5",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310939526",
            "telephone_number": "770-982-4886",
            "fax_number": "770-979-2275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENOVATION CHIROPRACTIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-12",
        "last_updated": "2014-05-05",
        "status": "A",
        "authorized_official_last_name": "PETTYGROVE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "JEREMY",
        "authorized_official_title_or_position": "PROVIDER/PRESIDENT",
        "authorized_official_telephone_number": "478-334-7958",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIRO009223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warner Robins, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.