Healthcare Provider Details

I. General information

NPI: 1609242585
Provider Name (Legal Business Name): REJUVINNATE FAMILY CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9137 E MINERAL CIR STE 380
CENTENNIAL CO
80112-3424
US

IV. Provider business mailing address

9137 E MINERAL CIR STE 380
CENTENNIAL CO
80112-3424
US

V. Phone/Fax

Practice location:
  • Phone: 303-975-6523
  • Fax:
Mailing address:
  • Phone: 303-975-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberCHR.0007110
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHR.0007141
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR.0007110
License Number StateCO

VIII. Authorized Official

Name: DR. VICTORIA LAI
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 720-633-4172