=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346848975
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGENERATIVE MEDICINE OF RICHMOND LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2020
-----------------------------------------------------
Last Update Date | 03/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8639 MAYLAND DR STE 105
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23294-4752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-740-7105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8639 MAYLAND DR STE 105
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23294-4752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-740-7105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRYANT DEANE SNYDER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 804-740-7105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------