Provider Demographics
NPI:1114376282
Name:SUNRISE BODY REVIVAL CHIROPRACTIC AND MASSSAGE
Entity type:Organization
Organization Name:SUNRISE BODY REVIVAL CHIROPRACTIC AND MASSSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-857-6171
Mailing Address - Street 1:3117 W COLUMBUS DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1866
Mailing Address - Country:US
Mailing Address - Phone:813-857-6171
Mailing Address - Fax:
Practice Address - Street 1:3117 W COLUMBUS DR
Practice Address - Street 2:SUITE 206
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1866
Practice Address - Country:US
Practice Address - Phone:813-857-6171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty