Healthcare Provider Details

I. General information

NPI: 1144043951
Provider Name (Legal Business Name): REJUV WELLNESS & DIAGNOSTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 CHESTER RD STE A
CHESTER VA
23831-1110
US

IV. Provider business mailing address

7806 SILVER MIST AVE
NORTH CHESTERFIELD VA
23237-1976
US

V. Phone/Fax

Practice location:
  • Phone: 804-764-0077
  • Fax:
Mailing address:
  • Phone: 804-586-6855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELISHA COLEMAN
Title or Position: CEO
Credential:
Phone: 804-586-8389