Provider Demographics
NPI:1952196503
Name:REVIVE CHIROPRACTIC CARE, LLC
Entity type:Organization
Organization Name:REVIVE CHIROPRACTIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:C
Authorized Official - Last Name:CINOUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-945-3928
Mailing Address - Street 1:8949 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-6918
Mailing Address - Country:US
Mailing Address - Phone:321-945-3928
Mailing Address - Fax:
Practice Address - Street 1:8949 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-6918
Practice Address - Country:US
Practice Address - Phone:321-945-3928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty