Provider Demographics
NPI:1568286862
Name:REVIVE CHIROPRACTIC AND WELLNESS, PLLC
Entity type:Organization
Organization Name:REVIVE CHIROPRACTIC AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-368-6295
Mailing Address - Street 1:115 WARBLER CT
Mailing Address - Street 2:
Mailing Address - City:VONORE
Mailing Address - State:TN
Mailing Address - Zip Code:37885-2046
Mailing Address - Country:US
Mailing Address - Phone:865-368-6295
Mailing Address - Fax:
Practice Address - Street 1:1740 US-411
Practice Address - Street 2:UNIT 1
Practice Address - City:VONORE
Practice Address - State:TN
Practice Address - Zip Code:37885
Practice Address - Country:US
Practice Address - Phone:423-420-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty