Provider Demographics
NPI:1164240156
Name:REJUVENATIVE WELLNESS LLC
Entity type:Organization
Organization Name:REJUVENATIVE WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:917-690-4730
Mailing Address - Street 1:117 MORNINGSIDE LANE
Mailing Address - Street 2:UNIT A
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650
Mailing Address - Country:US
Mailing Address - Phone:917-690-4730
Mailing Address - Fax:
Practice Address - Street 1:1600 PARKER AVE STE 1
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7050
Practice Address - Country:US
Practice Address - Phone:201-302-9993
Practice Address - Fax:201-302-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty