MEDICARE: REVOLVE PERFORMANCE REHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1184578098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVOLVE PERFORMANCE REHAB

Provider Business Mailing Address
First Line	:	560 HOLIDAY DR
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-7333
Country	:	US
Telephone Number	:	843-633-1363
Fax Number	:

Provider Business Practice Location Address
First Line	:	4540 RIVERS AVE UNIT 100
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-6926
Country	:	US
Telephone Number	:	843-633-1363
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KARL BAILEY
Credential	:	DC
Telephone Number	:	843-633-1363

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	03/23/2026

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Directions to “REVOLVE PERFORMANCE REHAB ” Practice Location

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