Provider Demographics
NPI:1306479837
Name:ADVANCED REGENERATIVE CARE OF CHARLOTTE, PLLC
Entity type:Organization
Organization Name:ADVANCED REGENERATIVE CARE OF CHARLOTTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-841-0240
Mailing Address - Street 1:504 RED BANKS RD STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5766
Mailing Address - Country:US
Mailing Address - Phone:252-321-3579
Mailing Address - Fax:
Practice Address - Street 1:10734B MONROE RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-8397
Practice Address - Country:US
Practice Address - Phone:704-841-0240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty