Provider Demographics
NPI:1285078428
Name:CHIROREVOLUTION
Entity type:Organization
Organization Name:CHIROREVOLUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOTTFRIED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-490-7386
Mailing Address - Street 1:5844 CYPRESS POINTE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9843
Mailing Address - Country:US
Mailing Address - Phone:812-480-5835
Mailing Address - Fax:
Practice Address - Street 1:8887 HIGH POINTE DR
Practice Address - Street 2:SUITE F
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-7969
Practice Address - Country:US
Practice Address - Phone:812-490-7386
Practice Address - Fax:812-490-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002502A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty