NPIMap

Organization Active NPI

Revitalife Center, P.a.

  • Chiropractor
  • Spring Lake Park, MN
National Provider Identifier
1225306608
Registry record updated Oct 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5552 Issued in MN
Legal business name
REVITALIFE CENTER, P.A.
Practice address
8097 Highway 65 NE Ste 102
Spring Lake Park, MN 55432-4511
Phone
(763) 710-4085
NPI assigned
Dec 13, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2012

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

Authorized official

Name
Dr. Linda Pham, D.C.NPI 1265727028
Title
Owner/Chiropractor
Phone
(763) 710-4085

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 5552 MN Primary

Addresses

Primary practice location

8097 Highway 65 NE Ste 102
Spring Lake Park, MN 55432-4511

Mailing address

8097 Highway 65 NE Ste 102
Spring Lake Park, MN 55432-4511
Phone (763) 710-4085

Other names 1

  • RevitaLife Center Doing business as

National Provider Directory

National Provider Directory

Locations

8097 Highway 65 NE
Ste 102
Spring Lake Park, MN 55432
Phone (763) 710-4085

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1225306608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8097 HIGHWAY 65 NE STE 102",
            "city": "SPRING LAKE PARK",
            "state": "MN",
            "postal_code": "554324511",
            "telephone_number": "763-710-4085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8097 HIGHWAY 65 NE STE 102",
            "city": "SPRING LAKE PARK",
            "state": "MN",
            "postal_code": "554324511",
            "telephone_number": "763-710-4085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIFE CENTER, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-13",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "763-710-4085",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RevitaLife Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spring Lake Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.