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General NPI Number Information
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NPI Number | 1841841186
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Entity Type | Organization
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Legal Business Name | REVIVE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/27/2019
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Last Update Date | 09/27/2019
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Provider Practice Location Address
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Address Line | 260 W MAIN ST STE 211
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-7311
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Country | US
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Telephone | 615-651-4471
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Fax |
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Provider Business Mailing Address
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Address Line | 4036 SUSSEX DR
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City | NASHVILLE
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State | TN
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Zip | 37207-1637
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Country | US
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Telephone | 513-781-6625
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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. JULIE PAUL
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Credential | DC
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Telephone | 513-781-6625
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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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