MEDICARE: REJUVENATING HEALTH AND WELLNESS LLC

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	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1568193076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REJUVENATING HEALTH AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	2361 S FLANDERS ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80013-9456
Country	:	US
Telephone Number	:	720-288-7625
Fax Number	:

Provider Business Practice Location Address
First Line	:	13731 E RICE PL STE 101
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-1063
Country	:	US
Telephone Number	:	720-288-7625
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SONYA THACKER
Credential	:	L.AC
Telephone Number	:	720-288-7625

Provider Enumeration Date	:	06/23/2022
Last Update Date	:	06/23/2022

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