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General NPI Number Information
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NPI Number | 1962024653
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Entity Type | Organization
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Legal Business Name | SOUTH DENVER REGEN INC
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Dates
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Enumeration Date | 05/15/2020
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Last Update Date | 05/15/2020
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Provider Practice Location Address
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Address Line | 8765 E ORCHARD RD STE 702
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-5009
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Country | US
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Telephone | 303-738-0390
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Fax | 866-238-2721
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Provider Business Mailing Address
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Address Line | 8765 E ORCHARD RD STE 702
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-5009
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Country | US
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Telephone | 303-738-0390
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Fax | 866-238-2721
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAWN JOHONNESSON
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Credential |
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Telephone | 303-738-0390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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