Revive Family Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

REVIVE FAMILY CHIROPRACTIC LLC

Practice address

343 E Maple Ave
Mundelein, IL 60060-1970

Phone

(847) 780-9005

NPI assigned

Sep 18, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Hyunjung Lee, DCNPI 1912680265

Title

Owner

Phone

(309) 252-0859

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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

• Hyunjung Lee, DC

  • Chiropractor
  • Mundelein, IL
  • NPI 1912680265
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1694995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694995200000",
    "number": "1467230722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 E MAPLE AVE",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600601970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 E MAPLE AVE",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600601970",
            "telephone_number": "847-780-9005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE FAMILY CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-18",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "HYUNJUNG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-252-0859",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Mundelein, IL
• Providers in Mundelein, IL by specialty
• Chiropractor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; 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.