Healthcare Provider Details

I. General information

NPI: 1790042943
Provider Name (Legal Business Name): REVIVE CHIROPRACTIC & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3546 SAINT JOHNS BLUFF RD S UNIT 204
JACKSONVILLE FL
32224-2716
US

IV. Provider business mailing address

3546 SAINT JOHNS BLUFF RD S UNIT 204
JACKSONVILLE FL
32224-2716
US

V. Phone/Fax

Practice location:
  • Phone: 904-996-2243
  • Fax:
Mailing address:
  • Phone: 904-996-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH3311
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9924
License Number StateFL

VIII. Authorized Official

Name: DR. ZACHARY W STALNAKER
Title or Position: MGRM/OWNER
Credential: D.C.
Phone: 904-996-2243