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General NPI Number Information
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NPI Number | 1467230722
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Entity Type | Organization
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Legal Business Name | REVIVE FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 343 E MAPLE AVE
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City | MUNDELEIN
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State | IL
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Zip | 60060-1970
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Country | US
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Telephone | 847-780-9005
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Fax |
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Provider Business Mailing Address
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Address Line | 343 E MAPLE AVE
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City | MUNDELEIN
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State | IL
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Zip | 60060-1970
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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 | DR. HYUNJUNG LEE
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Credential | DC
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Telephone | 309-252-0859
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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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