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General NPI Number Information
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NPI Number | 1093100414
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Entity Type | Organization
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Legal Business Name | REVIVE HEALTH CENTER, SC
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 3420 LACROSSE LN SUITE 100, OFFICE 2
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City | NAPERVILLE
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State | IL
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Zip | 60564-8245
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Country | US
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Telephone | 630-637-3420
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Fax | 630-637-3402
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Provider Business Mailing Address
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Address Line | 3420 LACROSSE LN SUITE 100, OFFICE 2
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City | NAPERVILLE
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State | IL
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Zip | 60564-8245
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Country | US
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Telephone | 630-637-3420
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Fax | 630-637-3402
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Authorized Official
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Title or Position | OWNER/CHIROPRACTIC PHYSICIAN
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Name | DR. REBECCA LAMARCHE
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Credential | DC
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Telephone | 630-637-3420
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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 | 038011472
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License Number State | IL
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