Healthcare Provider Details

I. General information

NPI: 1619077435
Provider Name (Legal Business Name): REGENT HEALTHCARE OF SCOTTSDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 N SCOTTSDALE RD STE 315
SCOTTSDALE AZ
85251-3999
US

IV. Provider business mailing address

4110 N SCOTTSDALE RD STE 315
SCOTTSDALE AZ
85251-3999
US

V. Phone/Fax

Practice location:
  • Phone: 480-609-4244
  • Fax: 480-609-4382
Mailing address:
  • Phone: 480-609-4244
  • Fax: 480-609-4382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4276
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7589
License Number StateAZ

VIII. Authorized Official

Name: DR. SHAWN MICHAEL MEYER
Title or Position: PRESIDENT, PHYSICIAN
Credential: DC, CCN
Phone: 480-609-4244