Provider Demographics
NPI:1699350827
Name:REVOLUTION WELLNESS INC.
Entity type:Organization
Organization Name:REVOLUTION WELLNESS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:NORIEGA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-867-7693
Mailing Address - Street 1:546 BRANDIES CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-7739
Mailing Address - Country:US
Mailing Address - Phone:615-867-7693
Mailing Address - Fax:
Practice Address - Street 1:546 BRANDIES CIR STE 103
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-7739
Practice Address - Country:US
Practice Address - Phone:615-867-7693
Practice Address - Fax:615-867-7695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center