Provider Demographics
NPI:1801089776
Name:BODY REGENERATION CENTER, LLC
Entity type:Organization
Organization Name:BODY REGENERATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:301-841-5191
Mailing Address - Street 1:3102 LOWE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-1439
Mailing Address - Country:US
Mailing Address - Phone:301-265-0886
Mailing Address - Fax:301-265-1103
Practice Address - Street 1:801 ROEDER RD
Practice Address - Street 2:SUITE 425
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4467
Practice Address - Country:US
Practice Address - Phone:301-558-8088
Practice Address - Fax:301-558-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty