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General NPI Number Information
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NPI Number | 1083187041
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Entity Type | Organization
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Legal Business Name | REVIVE CHIROPRACTIC HEALTH CENTER
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Dates
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Enumeration Date | 01/02/2019
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Last Update Date | 01/02/2019
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Provider Practice Location Address
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Address Line | 7600 W 20TH AVE STE 107
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City | HIALEAH
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State | FL
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Zip | 33016-1895
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Country | US
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Telephone | 786-401-6115
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Fax | 786-391-2608
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Provider Business Mailing Address
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Address Line | 7600 W 20TH AVE STE 107
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City | HIALEAH
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State | FL
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Zip | 33016-1895
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Country | US
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Telephone | 786-401-6115
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Fax | 786-391-2608
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Authorized Official
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Title or Position | DOCTOR
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Name | HECTOR LUIS ANDINO RIVERA II
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Credential | D.C.
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Telephone | 787-300-9902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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