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General NPI Number Information
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NPI Number | 1093284671
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Entity Type | Organization
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Legal Business Name | EXODUS REGENERATIVE MEDICINE LLC
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/30/2025
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Provider Practice Location Address
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Address Line | 104 EASTPARK DR STE 102
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City | BRENTWOOD
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State | TN
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Zip | 37027-7535
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Country | US
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Telephone | 615-445-7701
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Fax | 615-445-7771
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Provider Business Mailing Address
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Address Line | 104 EASTPARK DR STE 102
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City | BRENTWOOD
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State | TN
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Zip | 37027-7535
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Country | US
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Telephone | 615-445-7701
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Fax | 615-445-7771
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUSTIN KYLE ARD
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Credential | DC
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Telephone | 615-445-7701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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