# PUYALLUP REGENERATIVE MEDICINE, PLLC

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

## Provider details

- **NPI number:** 1740872944
- **Authorized official:** DR. MICHAEL LEE CHURCH DC (PRESIDENT)
- **Authorized official phone:** (253) 332-3628

## Contact information

- **Practice address:** 1410 S MERIDIAN STE A, PUYALLUP, WA 98371-6902
- **Practice address phone:** (253) 841-4425
- **Practice address fax:** (253) 445-5712
- **Mailing address:** PO BOX 1272, SUMNER, WA 98390-0250
- **Mailing address phone:** (253) 841-4425
- **Mailing address fax:** (253) 445-5712

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/09/2021
- **Last updated:** 04/28/2021