Provider Demographics
NPI:1841841186
Name:REVIVE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:REVIVE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-781-6625
Mailing Address - Street 1:4036 SUSSEX DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-1637
Mailing Address - Country:US
Mailing Address - Phone:513-781-6625
Mailing Address - Fax:
Practice Address - Street 1:260 W MAIN ST STE 211
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-7311
Practice Address - Country:US
Practice Address - Phone:615-651-4471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty