Revitalize Chiropractic, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

REVITALIZE CHIROPRACTIC, LLC

Practice address

936 Chesterfield Pkwy E
Chesterfield, MO 63017-2042

Phone

(636) 537-0564

Fax

(314) 775-9870

NPI assigned

Jan 14, 2018

Organization subpart

No

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

Authorized official

Name

Samantha Christine Chapel, DCNPI 1669989828

Title

Owner

Phone

(636) 537-0564

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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.

• Samantha Christine Chapel, DC

  • Chiropractor
  • Chesterfield, MO
  • NPI 1669989828
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1515888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634515200000",
    "number": "1780192674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "936 CHESTERFIELD PKWY E",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630172042",
            "telephone_number": "636-537-0564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "936 CHESTERFIELD PKWY E",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630172042",
            "telephone_number": "636-537-0564",
            "fax_number": "314-775-9870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-14",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A",
        "authorized_official_last_name": "CHAPEL",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-537-0564",
        "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 Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2021; 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.