Revive Chiropractic PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2757 Issued in SC

Legal business name

REVIVE CHIROPRACTIC PC

Practice address

1808 Second Baxter Xing
Ste 108
Fort Mill, SC 29708-6436

Phone

(803) 802-2225

Fax

(803) 802-2275

NPI assigned

Aug 7, 2014

Last updated

Aug 7, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Luke Mackinnon, DC

Title

President

Phone

(803) 802-2225

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1407369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407369600000",
    "number": "1821407594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 SECOND BAXTER XING",
            "address_2": "STE 108",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297086436",
            "telephone_number": "803-802-2225",
            "fax_number": "803-802-2275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 SECOND BAXTER XING",
            "address_2": "STE 108",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297086436",
            "telephone_number": "803-802-2225",
            "fax_number": "803-802-2275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-07",
        "last_updated": "2014-08-07",
        "status": "A",
        "authorized_official_last_name": "MACKINNON",
        "authorized_official_first_name": "LUKE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-802-2225",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "2757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Chiropractor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; 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.