Healthcare Provider Details

I. General information

NPI: 1447635826
Provider Name (Legal Business Name): REVIVE CHIROPRACTIC & ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 30TH AVE STE 110
HUTCHINSON KS
67502-2463
US

IV. Provider business mailing address

210 E 30TH AVE STE 110
HUTCHINSON KS
67502-2463
US

V. Phone/Fax

Practice location:
  • Phone: 620-259-6399
  • Fax: 620-259-6682
Mailing address:
  • Phone: 620-259-6399
  • Fax: 620-259-6682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number01-05713
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: JANELLE VIEYRA
Title or Position: OFFICE MANAGER
Credential:
Phone: 620-259-6399