Healthcare Provider Details

I. General information

NPI: 1639610397
Provider Name (Legal Business Name): DENVER REGENERATIVE HEALTH INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 04/15/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825 S GALENA ST STE 200
CENTENNIAL CO
80112-3630
US

IV. Provider business mailing address

6825 S GALENA ST STE 200
CENTENNIAL CO
80112-3630
US

V. Phone/Fax

Practice location:
  • Phone: 303-741-0990
  • Fax:
Mailing address:
  • Phone: 303-741-0990
  • Fax: 303-741-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMARA JOHNSON
Title or Position: OWNER
Credential:
Phone: 303-741-0990