Provider Demographics
NPI:1346966587
Name:REGENERATIVE MEDICINE OF IOWA PC
Entity type:Organization
Organization Name:REGENERATIVE MEDICINE OF IOWA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-223-7773
Mailing Address - Street 1:2910 WESTOWN PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1332
Mailing Address - Country:US
Mailing Address - Phone:515-223-7773
Mailing Address - Fax:949-543-2399
Practice Address - Street 1:2910 WESTOWN PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1332
Practice Address - Country:US
Practice Address - Phone:515-223-7773
Practice Address - Fax:949-543-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty