Provider Demographics
NPI:1447660790
Name:REVELS, KATIE (DC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:REVELS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:NE
Mailing Address - Zip Code:68064-0339
Mailing Address - Country:US
Mailing Address - Phone:531-200-5842
Mailing Address - Fax:531-213-4070
Practice Address - Street 1:333 N SPRUCE ST STE 101
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:NE
Practice Address - Zip Code:68064-9605
Practice Address - Country:US
Practice Address - Phone:402-640-1943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor