Provider Demographics
NPI:1437528023
Name:REVIVE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:REVIVE CHIROPRACTIC LLC
Other - Org Name:SIRAGUSO FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:P
Authorized Official - Last Name:SIRAGUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-272-3580
Mailing Address - Street 1:7825 N OAK TRFY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1426
Mailing Address - Country:US
Mailing Address - Phone:816-272-3580
Mailing Address - Fax:816-256-2714
Practice Address - Street 1:7825 N OAK TRFY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-1426
Practice Address - Country:US
Practice Address - Phone:816-272-3580
Practice Address - Fax:816-256-2714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015000688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA5953Medicare PIN