NPIMap

Organization Active NPI

Revive Chiropractic Inc

  • Chiropractor
  • Lewis Center, OH
National Provider Identifier
1063771186
Registry record updated May 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4274 Issued in OH
Legal business name
REVIVE CHIROPRACTIC INC
Practice address
1258 E Powell Rd
Lewis Center, OH 43035-8619
Phone
(614) 781-8808
NPI assigned
May 9, 2012
Last updated
May 22, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Samantha Shriner, D.C.NPI 1326306697
Title
Chiropractor
Phone
(269) 599-5986

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 4274 OH Primary

Addresses

Primary practice location

1258 E Powell Rd
Lewis Center, OH 43035-8619

Mailing address

6604 Albany Woods Blvd
New Albany, OH 43054-8649

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120621000302 OH Part B Supplier - Clinic/Group Practice 1254595317 Receives reassigned benefits from 5 practitioners
Practice locations: Lewis Center, OH

National Provider Directory

National Provider Directory

Locations

1258 E Powell Rd
Lewis Center, OH 43035
Phone (269) 599-5986

1311 Cameron Ave
Lewis Center, OH 43035
Phone (614) 781-8808

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337644800000",
    "number": "1063771186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6604 ALBANY WOODS BLVD",
            "city": "NEW ALBANY",
            "state": "OH",
            "postal_code": "430548649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1258 E POWELL RD",
            "city": "LEWIS CENTER",
            "state": "OH",
            "postal_code": "430358619",
            "telephone_number": "614-781-8808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE CHIROPRACTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-09",
        "last_updated": "2012-05-22",
        "status": "A",
        "authorized_official_last_name": "SHRINER",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "269-599-5986",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "4274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewis Center, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.