Revive PBG LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

REVIVE PBG LLC

Practice address

5320 Donald Ross Rd Ste 125
Palm Beach Gardens, FL 33418-7296

Phone

(561) 531-9320

Fax

(772) 413-7025

NPI assigned

May 25, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Matthew Joseph McNabb, DC

Title

Provider

Phone

(561) 531-9320

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621900800000",
    "number": "1417522186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5320 DONALD ROSS RD STE 125",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334187296",
            "telephone_number": "561-531-9320",
            "fax_number": "772-413-7025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5320 DONALD ROSS RD STE 125",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334187296",
            "telephone_number": "561-531-9320",
            "fax_number": "772-413-7025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE PBG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-25",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A",
        "authorized_official_last_name": "MCNABB",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "561-531-9320",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "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 May 25, 2021; 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.