Puyallup Regenerative Medicine, PLLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

PUYALLUP REGENERATIVE MEDICINE, PLLC

Practice address

1410 S Meridian Ste a
Puyallup, WA 98371-6902

Phone

(253) 841-4425

Fax

(253) 445-5712

NPI assigned

Feb 9, 2021

Last updated

Apr 28, 2021By 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

Dr. Michael Lee Church, DC

Title

President

Phone

(253) 332-3628

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619568000000",
    "number": "1740872944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1272",
            "city": "SUMNER",
            "state": "WA",
            "postal_code": "983900250",
            "telephone_number": "253-841-4425",
            "fax_number": "253-445-5712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 S MERIDIAN STE A",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983716902",
            "telephone_number": "253-841-4425",
            "fax_number": "253-445-5712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUYALLUP REGENERATIVE MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-09",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A",
        "authorized_official_last_name": "CHURCH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-332-3628",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Puyallup Open Imaging LLC
• Puyallup Park Dental
• Puyallup Pediatric Dentistry
• Puyallup Psychotherapeutic Alliance
• Puyallup Radiological Assocs, Inc.
• Puyallup School District
• Puyallup Spine and Injury Center
• Puyallup Valley Pediatric Associates, P.S.
• Puyallup Valley Physical Therapy, Inc. P. S.
• Puyallup Valley St. Francis House

• General Practice Physician in Puyallup, WA
• Providers in Puyallup, WA by specialty
• General Practice Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; 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.