Provider Demographics
NPI:1205591708
Name:REGENERATION NATION TULSA LLC
Entity type:Organization
Organization Name:REGENERATION NATION TULSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ROADHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-481-2772
Mailing Address - Street 1:6565 S YALE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8302
Mailing Address - Country:US
Mailing Address - Phone:918-481-2772
Mailing Address - Fax:918-481-2774
Practice Address - Street 1:6565 S YALE AVE STE 104
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8302
Practice Address - Country:US
Practice Address - Phone:918-481-2772
Practice Address - Fax:918-481-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty