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General NPI Number Information
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NPI Number | 1336730217
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Entity Type | Organization
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Legal Business Name | REVIVE HEALTH AND CHIROPRACTIC INC
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Dates
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Enumeration Date | 02/02/2021
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 891 W BAXTER DR
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8506
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Country | US
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Telephone | 509-270-3687
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Fax |
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Provider Business Mailing Address
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Address Line | 891 W BAXTER DR
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8506
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Country | US
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Telephone | 509-270-3687
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KYLE ROBERT GORDON
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Credential | DC
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Telephone | 801-899-9605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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