| Organization Name: | RENOVATION CHIROPRACTIC, INC. |
| NPI Number: | 1184048092 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN JEREMY PETTYGROVE (PROVIDER/PRESIDENT) |
| Mailing Address: | 3035 Watson Blvd Suite 5 Warner Robins |
| State: | GA US |
| Postal Code: | 310939526 |
| Phone Number: | 7709824886 |
| Fax Number: | 7709792275 |
| NPI Enumeration Date: | 02/12/2014 |
| NPI Last Update Date: | 05/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 111N00000X |
| License Number: | CHIRO009223 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Chiropractic Providers |
| Taxonomy Classification: | Chiropractor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |