Provider Demographics
NPI:1447635826
Name:REVIVE CHIROPRACTIC & ACUPUNCTURE LLC
Entity type:Organization
Organization Name:REVIVE CHIROPRACTIC & ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIEYRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-259-6399
Mailing Address - Street 1:210 E 30TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2463
Mailing Address - Country:US
Mailing Address - Phone:620-259-6399
Mailing Address - Fax:620-259-6682
Practice Address - Street 1:210 E 30TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2463
Practice Address - Country:US
Practice Address - Phone:620-259-6399
Practice Address - Fax:620-259-6682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
KS01-05713302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty