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General NPI Number Information
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NPI Number | 1194658948
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Entity Type | Organization
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Legal Business Name | REVIVE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 06/03/2026
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 1175 N LEATHERLEAF LOOP STE F
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City | WASILLA
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State | AK
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Zip | 99654-6527
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Country | US
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Telephone | 907-947-6319
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Fax |
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Provider Business Mailing Address
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Address Line | 1175 N LEATHERLEAF LOOP STE F
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City | WASILLA
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State | AK
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Zip | 99654-6527
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN LLOYD
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Credential | DC
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Telephone | 907-947-6319
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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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