Provider Demographics
NPI:1578299947
Name:REGATTA CHIROPRACTIC LASER AND WELLNESS CENTER INC
Entity Type:Organization
Organization Name:REGATTA CHIROPRACTIC LASER AND WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-424-7856
Mailing Address - Street 1:4481 LEGENDARY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5386
Mailing Address - Country:US
Mailing Address - Phone:850-424-7856
Mailing Address - Fax:850-424-7858
Practice Address - Street 1:4481 LEGENDARY DR STE 150
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5386
Practice Address - Country:US
Practice Address - Phone:850-424-7856
Practice Address - Fax:850-424-7858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty