Organization
REVIVE CHIROPRACTIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDON AUCKER (OWNER, OFFICE MANAGER)
(570) 621-4390
Entity
Organization
Contact information
Practice address
2205 W MARKET ST, POTTSVILLE, PA 17901-1803
(570) 621-4390
(570) 621-4296
Mailing address
2205 W MARKET ST, POTTSVILLE, PA 17901-1803
(570) 621-4390
(570) 621-4296
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1548773708
NPI
PA
Enumeration date
11/09/2017
Last updated
04/11/2019
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