Ilumina Life Center, P.C.

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

ILUMINA LIFE CENTER, P.C.

Doing business as

Regenerative Spine and Wellness Center

Practice address

211 Granite Run Dr Ste 221
Lancaster, PA 17601

Phone

(814) 467-4055

NPI assigned

Sep 3, 2014

Last updated

Jul 5, 2018By 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

Ms. Florentina Mayko

Title

Ceo

Phone

(814) 467-4055

Specialties & licenses 2

Addresses

Other names 1

• Regenerative Spine and Wellness Center Doing business as

Locations

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

{
    "created_epoch": "1409702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530748800000",
    "number": "1467852996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 YORK RD",
            "city": "CARLISLE",
            "state": "PA",
            "postal_code": "170133157",
            "telephone_number": "814-467-4055",
            "fax_number": "814-254-4092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 GRANITE RUN DR STE 221",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "17601",
            "telephone_number": "814-467-4055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "136 Jaycee Dr",
            "address_2": "Suite 10",
            "address_purpose": "LOCATION",
            "city": "Johnstown",
            "state": "PA",
            "postal_code": "159043650",
            "country_code": "US",
            "telephone_number": "814-467-4055",
            "fax_number": "814-262-8161",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "507 Tire Hill Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Johnstown",
            "state": "PA",
            "postal_code": "159057311",
            "country_code": "US",
            "telephone_number": "814-467-4055 x165",
            "fax_number": "814-254-4092",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ILUMINA LIFE CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-03",
        "last_updated": "2018-07-05",
        "status": "A",
        "authorized_official_last_name": "MAYKO",
        "authorized_official_first_name": "FLORENTINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "814-467-4055",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Regenerative Spine and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Multi-Specialty Clinic/Center in Lancaster, PA
• Providers in Lancaster, PA by specialty
• Multi-Specialty Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2018; 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.