Revive Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

REVIVE CHIROPRACTIC LLC

Practice address

12517 N Saginaw Blvd
Suite 201
Fort Worth, TX 76179

Phone

(817) 422-4246

Fax

(817) 288-0775

NPI assigned

Apr 7, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Nichole J Snyder, DCNPI 1134290653

Title

President

Phone

(817) 422-4246

Specialties & licenses 1

Addresses

Other names 1

• Revive Chiropractic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

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.

• Nichole J Snyder, D.C.

  • Chiropractor
  • Fort Worth, TX
  • NPI 1134290653
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1680825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680825600000",
    "number": "1508551300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2229 SUN STAR DR",
            "city": "HASLET",
            "state": "TX",
            "postal_code": "760523499",
            "telephone_number": "817-422-4246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12517 N SAGINAW BLVD",
            "address_2": "SUITE 201",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76179",
            "telephone_number": "817-422-4246",
            "fax_number": "817-288-0775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-07",
        "last_updated": "2023-04-07",
        "certification_date": "2023-04-03",
        "status": "A",
        "authorized_official_last_name": "SNYDER",
        "authorized_official_first_name": "NICHOLE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-422-4246",
        "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": [
        {
            "organization_name": "Revive Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Chiropractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.