NPIMap

Organization Active NPI

Revitalize Chiropractic LLC

  • Chiropractor
  • Omaha, NE
National Provider Identifier
1467702951
Registry record updated Jan 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1726 Issued in NE
Legal business name
REVITALIZE CHIROPRACTIC LLC
Practice address
8013 L St
Omaha, NE 68127
Phone
(402) 592-7686
Fax
(402) 592-0689
NPI assigned
Sep 12, 2012
Last updated
Jan 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2013

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

Authorized official

Name
Dr. Timothy John Sullivan, DCNPI 1508113291
Title
Chiropractor
Phone
(402) 592-7686

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
Chiropractor 111N00000X 1726 NE Primary

Addresses

Primary practice location

8013 L St
Omaha, NE 68127

Mailing address

8013 L St
Omaha, NE 68127
Phone (402) 592-7686

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1347408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358899200000",
    "number": "1467702951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8013 L ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68127",
            "telephone_number": "402-592-7686",
            "fax_number": "402-592-0689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8013 L ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68127",
            "telephone_number": "402-592-7686",
            "fax_number": "402-592-0689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-12",
        "last_updated": "2013-01-23",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "402-592-7686",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NE",
            "license": "1726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; 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.