Provider Demographics
NPI:1609547264
Name:REVIVE ACUPUNCTURE & ORIENTAL MEDICINE
Entity Type:Organization
Organization Name:REVIVE ACUPUNCTURE & ORIENTAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-232-3103
Mailing Address - Street 1:665 HANCOCK ST STE 1
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-2858
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:665 HANCOCK ST STE 1
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-2858
Practice Address - Country:US
Practice Address - Phone:857-232-3103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty