Provider Demographics
NPI:1831740489
Name:REGENERATIVE MEDICINE OF ALABAMA
Entity type:Organization
Organization Name:REGENERATIVE MEDICINE OF ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:ERIKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:334-699-4299
Mailing Address - Street 1:2500 FLOWERS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-8300
Mailing Address - Country:US
Mailing Address - Phone:334-996-4299
Mailing Address - Fax:334-792-0210
Practice Address - Street 1:2500 FLOWERS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-8300
Practice Address - Country:US
Practice Address - Phone:334-996-4299
Practice Address - Fax:334-792-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty