MEDICARE: REVIVE CHIROPRACTIC LLC

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	2015000688	MO

General Provider Information

NPI Number	:	1437528023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	7825 N OAK TRFY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-1426
Country	:	US
Telephone Number	:	816-272-3580
Fax Number	:	816-256-2714

Provider Business Practice Location Address
First Line	:	7825 N OAK TRFY
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-1426
Country	:	US
Telephone Number	:	816-272-3580
Fax Number	:	816-256-2714

Authorized Official
Title or Position	:	DOCTOR
Name	:	FRANK P SIRAGUSO
Credential	:	DC
Telephone Number	:	816-272-3580

Provider Enumeration Date	:	09/24/2015
Last Update Date	:	01/17/2022

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