Provider Demographics
NPI:1508186222
Name:HEALTH REVOLUTION, PC
Entity Type:Organization
Organization Name:HEALTH REVOLUTION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-882-8845
Mailing Address - Street 1:1816 S MAIN ST STE B3
Mailing Address - Street 2:PO BOX 2443
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-7707
Mailing Address - Country:US
Mailing Address - Phone:903-882-8845
Mailing Address - Fax:
Practice Address - Street 1:1816 S MAIN ST STE B3
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-7707
Practice Address - Country:US
Practice Address - Phone:903-882-8845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty