| Organization Name: | REVIVE INJURY AND WELLNESS, PC |
| NPI Number: | 1952698680 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ERIN DANIELLE BLOOM (PRESIDENT) |
| Mailing Address: | 1750 Blankenship Rd Ste 295 West Linn |
| State: | OR US |
| Postal Code: | 970685101 |
| Phone Number: | 5033444378 |
| Fax Number: | 5033343604 |
| NPI Enumeration Date: | 07/01/2011 |
| NPI Last Update Date: | 06/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 111N00000X |
| License Number: | 4107 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Chiropractic Providers |
| Taxonomy Classification: | Chiropractor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |