Provider Demographics
NPI:1437589496
Name:REVOLUTION CHIROPRACTIC
Entity Type:Organization
Organization Name:REVOLUTION CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSCHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-284-9875
Mailing Address - Street 1:8410 WADSWORTH BLVD
Mailing Address - Street 2:UNIT A
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-0917
Mailing Address - Country:US
Mailing Address - Phone:303-284-9875
Mailing Address - Fax:303-284-1639
Practice Address - Street 1:8410 WADSWORTH BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-0917
Practice Address - Country:US
Practice Address - Phone:303-284-9875
Practice Address - Fax:303-284-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015359261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service