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General NPI Number Information
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NPI Number | 1629311709
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Entity Type | Organization
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Legal Business Name | REVIVE CHIROPRACTIC AND REHABILITATION LLC
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 12875 ROUTE 30 STE 25
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City | NORTH HUNTINGDON
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State | PA
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Zip | 15642-2595
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Country | US
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Telephone | 724-382-5576
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Fax |
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Provider Business Mailing Address
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Address Line | 12875 ROUTE 30 STE 25
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City | NORTH HUNTINGDON
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State | PA
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Zip | 15642-2595
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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 LLC
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Name | PRESTON MULLENS
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Credential |
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Telephone | 814-335-0454
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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 | DC010524
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License Number State | PA
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