Provider Demographics
NPI:1649986514
Name:RECIPE FOR REGENERATION
Entity type:Organization
Organization Name:RECIPE FOR REGENERATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-260-4567
Mailing Address - Street 1:10106 E 79TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4555
Mailing Address - Country:US
Mailing Address - Phone:918-770-0248
Mailing Address - Fax:918-770-0250
Practice Address - Street 1:10106 E 79TH ST STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4555
Practice Address - Country:US
Practice Address - Phone:918-770-0248
Practice Address - Fax:918-770-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty