Executive Regenerative Health

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

EXECUTIVE REGENERATIVE HEALTH

Practice address

3815 Highway 66 S Ste 1
Rogersville, TN 37857-5197

Phone

(866) 214-6774

NPI assigned

Jul 14, 2025

Last updated

Jul 14, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chad Perigo

Title

Ceo

Phone

(559) 730-6083

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1752451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752451200000",
    "number": "1437040706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2052 MEMORY LN",
            "city": "PORTERVILLE",
            "state": "CA",
            "postal_code": "932576298",
            "telephone_number": "559-730-6083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 HIGHWAY 66 S STE 1",
            "city": "ROGERSVILLE",
            "state": "TN",
            "postal_code": "378575197",
            "telephone_number": "866-214-6774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE REGENERATIVE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-14",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A",
        "authorized_official_last_name": "PERIGO",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "559-730-6083"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas Chase Edwards, PT, DPT
• Penny Rena Edwards, LPN
• Kay B Elkins, RNC
• Evolution Medical and Aesthetics PLLC
• James Robert Ewing, ARRT RT
• Paul Douglas Fairbanks, LCPC / LPC
• Fast Pace Medical Clinic PLLC
• Mary Jane Fink
• Glenn Bruce Finney, DDS
• First Med of Rogersville

• Clinic/Center in Rogersville, TN
• Providers in Rogersville, TN by specialty
• Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.