Provider Demographics
NPI:1992567424
Name:REVIVIFY CHIROPRACTIC WELLNESS CENTER
Entity type:Organization
Organization Name:REVIVIFY CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:CAROLINA
Authorized Official - Last Name:CRUZ-LAMBOY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:787-422-9213
Mailing Address - Street 1:3528 ADIRONDACK WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0166
Mailing Address - Country:US
Mailing Address - Phone:910-679-4079
Mailing Address - Fax:
Practice Address - Street 1:3528 ADIRONDACK WAY STE 120
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0166
Practice Address - Country:US
Practice Address - Phone:910-679-4079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center