Provider Demographics
NPI:1497084420
Name:REVIVE CHIROPRACTIC & REHABILITATION CARE LTD.
Entity Type:Organization
Organization Name:REVIVE CHIROPRACTIC & REHABILITATION CARE LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WITOLD
Authorized Official - Middle Name:T
Authorized Official - Last Name:GOZDALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-282-4300
Mailing Address - Street 1:9711 SKOKIE BLVD
Mailing Address - Street 2:STE. #F
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1384
Mailing Address - Country:US
Mailing Address - Phone:773-282-4300
Mailing Address - Fax:773-282-4301
Practice Address - Street 1:9711 SKOKIE BLVD
Practice Address - Street 2:STE. #F
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1384
Practice Address - Country:US
Practice Address - Phone:773-282-4300
Practice Address - Fax:773-282-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty