Provider Demographics
NPI:1386163228
Name:REGENERATIVE MEDSPA PLLC
Entity type:Organization
Organization Name:REGENERATIVE MEDSPA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EHREN
Authorized Official - Last Name:DOTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-292-1735
Mailing Address - Street 1:4446 E CHAPAROSA WAY
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-7815
Mailing Address - Country:US
Mailing Address - Phone:480-292-1735
Mailing Address - Fax:
Practice Address - Street 1:4446 E CHAPAROSA WAY
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-7815
Practice Address - Country:US
Practice Address - Phone:480-292-1735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty