Renew Spine Center, PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4464 Issued in NC

Legal business name

RENEW SPINE CENTER, PC

Practice address

6 Park PL W
Brevard, NC 28712-3081

Phone

(828) 883-8262

Fax

(828) 883-8264

NPI assigned

Aug 15, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Jasen Todd Van Dyke, DCNPI 1063855203

Title

Owner

Phone

(828) 883-8262

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

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

• Jasen Todd Vandyke, DC

  • Chiropractor
  • Brevard, NC
  • NPI 1063855203
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1408060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669939200000",
    "number": "1649679630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 PARK PL W",
            "city": "BREVARD",
            "state": "NC",
            "postal_code": "287123081",
            "telephone_number": "828-883-8262",
            "fax_number": "828-883-8264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 PARK PL W",
            "city": "BREVARD",
            "state": "NC",
            "postal_code": "287123081",
            "telephone_number": "828-883-8262",
            "fax_number": "828-883-8264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW SPINE CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-15",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A",
        "authorized_official_last_name": "VAN DYKE",
        "authorized_official_first_name": "JASEN",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "828-883-8262",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "4464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Anne Raxter
• Bruce Howard Redler, MD
• Theresa Katherine Redmond, NP
• Susan Reid
• Noah Reisig
• Reset Physical Therapy and Wellness
• Rha Health Services NC, LLC
• John Lanier Rice, M.D.
• Heather Ruth Richardson, LCMHC
• Jessica Fowler Riddle, DPT

• Chiropractor in Brevard, NC
• Providers in Brevard, NC by specialty
• Chiropractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; 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.