Renaissance Chiropractic and Rehabilitation Center, LLC

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

38MC00711800 Issued in NJ

Legal business name

RENAISSANCE CHIROPRACTIC AND REHABILITATION CENTER, LLC

Practice address

413 Lakehurst Rd
BLDG 2
Toms River, NJ 08755-7382

Phone

(609) 626-4008

Fax

(732) 737-9030

NPI assigned

May 1, 2014

Organization subpart

No

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

Authorized official

Name

Manal Mena, D.C.

Title

Chiropractor

Phone

(609) 626-4008

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1398902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437523200000",
    "number": "1669882486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 HOLLY DR",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080558843",
            "telephone_number": "609-626-4008",
            "fax_number": "732-737-9030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 LAKEHURST RD",
            "address_2": "BLDG 2",
            "city": "TOMS RIVER",
            "state": "NJ",
            "postal_code": "087557382",
            "telephone_number": "609-626-4008",
            "fax_number": "732-737-9030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE CHIROPRACTIC AND REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-01",
        "last_updated": "2015-07-22",
        "status": "A",
        "authorized_official_last_name": "MENA",
        "authorized_official_first_name": "MANAL",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "609-626-4008",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "NJ",
            "license": "38MC00711800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.