Revive Wellness and Chiropractic Center

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

085133 Issued in IA

Legal business name

REVIVE WELLNESS AND CHIROPRACTIC CENTER

Practice address

808 5TH St
Coralville, IA 52241-2321

Phone

(319) 333-1299

NPI assigned

Feb 5, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Tina Baade, D.C.

Title

Chiropractor

Phone

(319) 333-1299

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1517788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517788800000",
    "number": "1396244471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "890 GROUSE LN",
            "city": "NORTH LIBERTY",
            "state": "IA",
            "postal_code": "523174855",
            "telephone_number": "319-621-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 5TH ST",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522412321",
            "telephone_number": "319-333-1299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE WELLNESS AND CHIROPRACTIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-05",
        "last_updated": "2018-02-05",
        "status": "A",
        "authorized_official_last_name": "BAADE",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "319-333-1299",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IA",
            "license": "085133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2018; 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.