Provider Demographics
NPI:1689550147
Name:REVIVE CHIROPRACTIC CENTRE, LLC
Entity type:Organization
Organization Name:REVIVE CHIROPRACTIC CENTRE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-907-0614
Mailing Address - Street 1:941 GROMORE RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-9509
Mailing Address - Country:US
Mailing Address - Phone:509-907-0614
Mailing Address - Fax:509-236-1859
Practice Address - Street 1:811 W YAKIMA AVE STE 104
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3088
Practice Address - Country:US
Practice Address - Phone:509-949-6920
Practice Address - Fax:509-236-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty