Organization
REVIVE CHIROPRACTIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSICA ANNA CARDEN D.C. (OWNER)
(231) 334-3123
Entity
Organization
Contact information
Practice address
6665 WESTERN AVE, GLEN ARBOR, MI 49636-5103
(231) 334-3123
Mailing address
890 E NARLOCK RD, MAPLE CITY, MI 49664-8767
(231) 334-3123
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301009253
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OP43110
CMS
MI
Enumeration date
05/07/2008
Last updated
09/03/2008
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