Healthcare Provider Details

I. General information

NPI: 1669939625
Provider Name (Legal Business Name): REGENERATIVE HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 HILLTOP RD STE 170
SHAWNEE KS
66226-3562
US

IV. Provider business mailing address

5111 W 158TH TER
OVERLAND PARK KS
66224-3896
US

V. Phone/Fax

Practice location:
  • Phone: 913-440-4017
  • Fax: 913-642-0653
Mailing address:
  • Phone: 206-313-2811
  • Fax: 913-246-0653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBYN RACHELLE DESAUTEL
Title or Position: OWNER
Credential: DC
Phone: 206-313-2811