Active NPI
Revive Chiropractic and Rehabilitation LLC
- Chiropractor
- North Huntingdon, PA
National Provider Identifier
1629311709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC010524
- Legal business name
- REVIVE CHIROPRACTIC AND REHABILITATION LLC
- Practice address
- 12875 Route 30 Ste 25
North Huntingdon, PA 15642-2595 - Phone
- (724) 382-5576
- NPI assigned
- Mar 27, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Preston Mullens
- Title
- Owner LLC
- Phone
- (814) 335-0454
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC010524 | PA | Primary |
Addresses
Primary practice location
12875 Route 30 Ste 25
North Huntingdon, PA 15642-2595
Mailing address
12875 Route 30 Ste 25
North Huntingdon, PA 15642-2595
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
National Provider Directory
National Provider Directory- Tax ID family
- Revive Chiropractic and Rehabilitation LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Chiropractor
- North Huntingdon, PA
- NPI 1538505581
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Student in an Organized Health Care Education/Training Program
- North Huntingdon, PA
- NPI 1821394172
-
- Chiropractor
- North Huntingdon, PA
- NPI 1205542552
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364342400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1393372800000",
"number": "1629311709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12875 ROUTE 30 STE 25",
"city": "NORTH HUNTINGDON",
"state": "PA",
"postal_code": "156422595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12875 ROUTE 30 STE 25",
"city": "NORTH HUNTINGDON",
"state": "PA",
"postal_code": "156422595",
"telephone_number": "724-382-5576"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "REVIVE CHIROPRACTIC AND REHABILITATION LLC",
"organizational_subpart": "NO",
"enumeration_date": "2013-03-27",
"last_updated": "2014-02-26",
"status": "A",
"authorized_official_last_name": "MULLENS",
"authorized_official_first_name": "PRESTON",
"authorized_official_title_or_position": "OWNER LLC",
"authorized_official_telephone_number": "814-335-0454"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Chiropractor",
"state": "PA",
"license": "DC010524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Huntingdon, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2014; 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.