Provider Demographics
NPI:1093100414
Name:REVIVE HEALTH CENTER, SC
Entity Type:Organization
Organization Name:REVIVE HEALTH CENTER, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMARCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-637-3420
Mailing Address - Street 1:3420 LACROSSE LN
Mailing Address - Street 2:SUITE 100, OFFICE 2
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8245
Mailing Address - Country:US
Mailing Address - Phone:630-637-3420
Mailing Address - Fax:630-637-3402
Practice Address - Street 1:3420 LACROSSE LN
Practice Address - Street 2:SUITE 100, OFFICE 2
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8245
Practice Address - Country:US
Practice Address - Phone:630-637-3420
Practice Address - Fax:630-637-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty