# REGENERATIVE WELLNESS CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144694480
- **Authorized official:** MICHAEL WILLIAMS (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (636) 272-8891

## Contact information

- **Practice address:** 8633 MEXICO RD, O FALLON, MO 63366-7506
- **Practice address phone:** (636) 272-8888
- **Practice address fax:** (636) 272-7385
- **Mailing address:** 8633 MEXICO RD, O FALLON, MO 63366-7506
- **Mailing address phone:** (636) 272-8888
- **Mailing address fax:** (636) 272-7385

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 2009009432 | MO | Yes |

## Other

- **Enumeration date:** 11/24/2015
- **Last updated:** 11/24/2015