Provider Demographics
NPI:1629245212
Name:REGENERATIVE SOLUTION PC
Entity Type:Organization
Organization Name:REGENERATIVE SOLUTION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JO
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-988-1825
Mailing Address - Street 1:11757 W KEN CARYL AVE
Mailing Address - Street 2:UNIT #269
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5935 S ZANG ST
Practice Address - Street 2:SUITE #260
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127
Practice Address - Country:US
Practice Address - Phone:303-988-1825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15671410000261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service