Provider Demographics
NPI:1437786449
Name:REV CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:REV CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-616-8111
Mailing Address - Street 1:2839 35TH AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9440
Mailing Address - Country:US
Mailing Address - Phone:970-616-8111
Mailing Address - Fax:970-616-8222
Practice Address - Street 1:2839 35TH AVE UNIT C
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-9440
Practice Address - Country:US
Practice Address - Phone:970-616-8111
Practice Address - Fax:970-616-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty