MEDICARE: REGENERATION HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN1001X	Nutrition Chiropractor	14560	CA

General Provider Information

NPI Number	:	1124553029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENERATION HEALTH, INC.

Provider Business Mailing Address
First Line	:	21515 HAWTHORNE BLVD
Second Line	:	SUITE 200
City	:	TORRANCE
State	:	CA
Zip	:	90503-6501
Country	:	US
Telephone Number	:	206-330-6054
Fax Number	:

Provider Business Practice Location Address
First Line	:	21515 HAWTHORNE BLVD
Second Line	:	SUITE 200
City	:	TORRANCE
State	:	CA
Zip	:	90503-6501
Country	:	US
Telephone Number	:	206-330-6054
Fax Number	:

Authorized Official
Title or Position	:	CHIEF HEALTH OFFICER
Name	:	DR. MICHAEL RYAN JOSEPH
Credential	:	DC, NMD
Telephone Number	:	206-330-6054

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	04/27/2017

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