Provider Demographics
NPI:1356223465
Name:REVIVAL CHIROPRACTIC
Entity type:Organization
Organization Name:REVIVAL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-492-2269
Mailing Address - Street 1:8670 WOLFF CT STE 165
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6969
Mailing Address - Country:US
Mailing Address - Phone:262-492-2269
Mailing Address - Fax:
Practice Address - Street 1:8670 WOLFF CT STE 165
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6969
Practice Address - Country:US
Practice Address - Phone:262-492-2269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty