Provider Demographics
NPI:1962112193
Name:REVITAL CHIROPRACTIC & WELLNESS PLLC
Entity type:Organization
Organization Name:REVITAL CHIROPRACTIC & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIANNE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-558-0522
Mailing Address - Street 1:700 N GREEN ST STE 303
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5996
Mailing Address - Country:US
Mailing Address - Phone:312-667-3663
Mailing Address - Fax:
Practice Address - Street 1:700 N GREEN ST STE 303
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-5996
Practice Address - Country:US
Practice Address - Phone:312-667-3663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty