Healthcare Provider Details

I. General information

NPI: 1285173625
Provider Name (Legal Business Name): REGENERATIVE MEDICINE INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 N STANLEY ST
MEDICAL LAKE WA
99022-8940
US

IV. Provider business mailing address

731 N STANLEY ST
MEDICAL LAKE WA
99022-8940
US

V. Phone/Fax

Practice location:
  • Phone: 509-299-6900
  • Fax: 509-351-2818
Mailing address:
  • Phone: 509-299-6900
  • Fax: 509-351-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER WELLWOOD
Title or Position: CHIROPRACTOR, OWNER
Credential: DC
Phone: 509-299-6900