MEDICARE: REVITALIZE HEALTH & WELLNESS, 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

General Provider Information

NPI Number	:	1619609781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVITALIZE HEALTH & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	6125 UPTON AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-2927
Country	:	US
Telephone Number	:	817-357-0711
Fax Number	:

Provider Business Practice Location Address
First Line	:	3018 W 56TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-2474
Country	:	US
Telephone Number	:	817-357-0711
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOYCE CUNDIFF
Credential	:	DC
Telephone Number	:	612-361-0068

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	06/28/2022

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