Healthcare Provider Details

I. General information

NPI: 1952196503
Provider Name (Legal Business Name): REVIVE CHIROPRACTIC CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8949 W COLONIAL DR
OCOEE FL
34761-6918
US

IV. Provider business mailing address

8949 W COLONIAL DR
OCOEE FL
34761-6918
US

V. Phone/Fax

Practice location:
  • Phone: 321-945-3928
  • Fax:
Mailing address:
  • Phone: 321-945-3928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. FARAH C CINOUS
Title or Position: CEO
Credential: DC
Phone: 321-945-3928