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General NPI Number Information
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NPI Number | 1689550147
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Entity Type | Organization
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Legal Business Name | REVIVE CHIROPRACTIC CENTRE, LLC
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 811 W YAKIMA AVE STE 104
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City | YAKIMA
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State | WA
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Zip | 98902-3088
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Country | US
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Telephone | 509-949-6920
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Fax | 509-236-1859
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Provider Business Mailing Address
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Address Line | 941 GROMORE RD
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City | YAKIMA
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State | WA
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Zip | 98908-9509
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Country | US
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Telephone | 509-907-0614
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Fax | 509-236-1859
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Authorized Official
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Title or Position | OWNER
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Name | JAMES DANIEL BROWN
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Credential | DC
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Telephone | 509-907-0614
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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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