Provider Demographics
NPI:1619642824
Name:REVIVE SPINAL CARE, LLC
Entity Type:Organization
Organization Name:REVIVE SPINAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-735-8377
Mailing Address - Street 1:213 E BUTLER RD STE A2
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2172
Mailing Address - Country:US
Mailing Address - Phone:864-735-8377
Mailing Address - Fax:
Practice Address - Street 1:213 E BUTLER RD STE A2
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2172
Practice Address - Country:US
Practice Address - Phone:864-735-8377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty