Provider Demographics
NPI:1912515289
Name:REVIVAL HEALTH LLC
Entity Type:Organization
Organization Name:REVIVAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-485-7518
Mailing Address - Street 1:9 POST RD STE D3
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-1615
Mailing Address - Country:US
Mailing Address - Phone:201-485-7518
Mailing Address - Fax:201-485-7517
Practice Address - Street 1:9 POST RD STE D3
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-1615
Practice Address - Country:US
Practice Address - Phone:201-485-7518
Practice Address - Fax:201-485-7517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty