| Revitaspine | |
|
210 Jupiter Lakes Blvd Ste 5205 Jupiter FL 33458 | |
| (561) 633-4142 | |
| (561) 803-8708 |
| Full Name | Revitaspine |
|---|---|
| Speciality | Clinic/Center |
| Location | 210 Jupiter Lakes Blvd Ste 5205, Jupiter, Florida |
| Authorized Official Name and Position | Jonn A Mcclellan (OWNER) |
| Authorized Official Contact | 5616022888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitaspine 8439 E Garden Oaks Cir Palm Beach Gardens FL 33410-6369 Ph: (561) 768-5699 | Revitaspine 210 Jupiter Lakes Blvd Ste 5205 Jupiter FL 33458 Ph: (561) 633-4142 |
| NPI Number | 1629594866 |
|---|---|
| Provider Enumeration Date | 08/18/2017 |
| Last Update Date | 07/12/2018 |
| Medicare PECOS PAC ID | 4789935966 |
|---|---|
| Medicare Enrollment ID | O20180927001132 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629594866 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | CH9815 (Florida) | Primary |
| Provider Name | Courtney Danielle Thomas Gray |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1588988927 PECOS PAC ID: 1052441151 Enrollment ID: I20100616000814 |
| Provider Name | Michael E Davis |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1558474528 PECOS PAC ID: 5991705568 Enrollment ID: I20101108000090 |
| Provider Name | Jonn A Mcclellan |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1629209523 PECOS PAC ID: 5496936916 Enrollment ID: I20110309000032 |
| Provider Name | Scott J Merz |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1821150830 PECOS PAC ID: 8224256276 Enrollment ID: I20140904001268 |
| Provider Name | Josee Yang |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1093018210 PECOS PAC ID: 3274801717 Enrollment ID: I20170624000102 |
| Provider Name | Anthony Pfister |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1760797633 PECOS PAC ID: 2264713023 Enrollment ID: I20200406000848 |
| Provider Name | Kyle J Lewis |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1306491535 PECOS PAC ID: 8022446251 Enrollment ID: I20200406002111 |
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