MEDICARE: REGENERATIVE MEDSPA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	7669	AZ

General Provider Information

NPI Number	:	1386163228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENERATIVE MEDSPA PLLC

Provider Business Mailing Address
First Line	:	16601 N 40TH ST STE 125
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3355
Country	:	US
Telephone Number	:	480-292-1735
Fax Number	:	480-383-6516

Provider Business Practice Location Address
First Line	:	16601 N 40TH ST STE 125
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3355
Country	:	US
Telephone Number	:	480-292-1735
Fax Number	:	480-383-6516

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT EHREN DOTY
Credential	:	DC
Telephone Number	:	480-292-1735

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	01/16/2026

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