# REVIVE SPORTS & SPINE MANAGEMENT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679195465
- **Authorized official:** DR. HAROUN ALI FETTEH DC (DOCTOR/OWNER)
- **Authorized official phone:** (313) 790-3998

## Contact information

- **Practice address:** 27253 VAN DYKE AVE, WARREN, MI 48093-2858
- **Practice address phone:** (586) 486-4520
- **Mailing address:** PO BOX 7175, DEARBORN, MI 48121-7175
- **Mailing address phone:** (313) 790-3998

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 05/14/2020
- **Last updated:** 05/14/2020