MEDICARE: EXECUTIVE REGENERATIVE HEALTH

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1437040706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXECUTIVE REGENERATIVE HEALTH

Provider Business Mailing Address
First Line	:	2052 MEMORY LN
Second Line	:
City	:	PORTERVILLE
State	:	CA
Zip	:	93257-6298
Country	:	US
Telephone Number	:	559-730-6083
Fax Number	:

Provider Business Practice Location Address
First Line	:	3815 HIGHWAY 66 S STE 1
Second Line	:
City	:	ROGERSVILLE
State	:	TN
Zip	:	37857-5197
Country	:	US
Telephone Number	:	866-214-6774
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHAD PERIGO
Credential	:
Telephone Number	:	559-730-6083

Provider Enumeration Date	:	07/14/2025
Last Update Date	:	07/14/2025

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