Provider Demographics
NPI:1669939625
Name:REGENERATIVE HEALTH CENTER LLC
Entity type:Organization
Organization Name:REGENERATIVE HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:DESAUTEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-313-2811
Mailing Address - Street 1:5111 W 158TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3896
Mailing Address - Country:US
Mailing Address - Phone:206-313-2811
Mailing Address - Fax:913-246-0653
Practice Address - Street 1:6850 HILLTOP RD STE 170
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-3562
Practice Address - Country:US
Practice Address - Phone:913-440-4017
Practice Address - Fax:913-642-0653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedicGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty