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Revitalize Chiropractic and Sport LLC

Details

Name: Revitalize Chiropractic and Sport LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 25 Jan 2022 (3 years ago) (Companies founded in January 2022)
Entity Number: 000-963-647
Register Number: 000963647
ZIP code: 36203 (Companies in Calhoun, 36203)
County: Calhoun
Place of Formation: Alabama
Registered Office Street Address: 314 Monger StreetOxford, AL 36203

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1629828157 2024-03-26 2024-03-26 14814 IMPERIAL DR, ATHENS, AL, 356137456, US 27453 CAPSHAW RD STE E, ATHENS, AL, 356137565, US

Contacts

Phone +1 256-343-4493

Authorized person

Name DR. TRINA CLARK
Role DOCTOR/OWNER
Phone 2563434493

Taxonomy

Taxonomy Code 111N00000X - Chiropractor
Is Primary Yes

Agent

Name Role
Clark, Trina G Clark Agent

Date of last update: 17 Aug 2024

Sources: Alabama Secretary of State