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General NPI Number Information
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NPI Number | 1669946638
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Entity Type | Individual
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Provider Name | RYAN ADAM REVELS DC
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Gender | Male
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Dates
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Enumeration Date | 01/14/2019
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 433 SILVER BEACH AVE STE 101
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-7104
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Country | US
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Telephone | 386-682-9350
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Fax |
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Provider Business Mailing Address
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Address Line | 4711 CHARDONNAY LN
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City | PORT ORANGE
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State | FL
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Zip | 32129-7481
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Country | US
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Telephone | 386-682-9350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12705
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License Number State | FL
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