Provider Demographics
NPI:1417420126
Name:JOINT REGENERATIVE LLC
Entity Type:Organization
Organization Name:JOINT REGENERATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-429-0404
Mailing Address - Street 1:4340 E INDIAN SCHOOL RD STE 21-536
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5360
Mailing Address - Country:US
Mailing Address - Phone:602-429-0404
Mailing Address - Fax:480-603-3244
Practice Address - Street 1:4340 E INDIAN SCHOOL RD STE 21-536
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5360
Practice Address - Country:US
Practice Address - Phone:602-429-0404
Practice Address - Fax:480-603-3244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty