# AXIS REJUVENATION LLC

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

## Provider details

- **NPI number:** 1972085371
- **Authorized official:** DANIEL DRAPER (PARTNER)
- **Authorized official phone:** (801) 953-5323

## Contact information

- **Practice address:** 100 BOSA DR STE A, SAINT ROBERT, MO 65584-4833
- **Practice address phone:** (573) 337-4568
- **Practice address fax:** (573) 336-2256
- **Mailing address:** 100 BOSA DR STE A, SAINT ROBERT, MO 65584-4833
- **Mailing address phone:** (801) 953-5323
- **Mailing address fax:** (801) 336-2256

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/31/2018
- **Last updated:** 12/30/2019