Provider Demographics
NPI:1093778110
Name:RPK CENTER FOR REHAB, SPINE & PAIN
Entity Type:Organization
Organization Name:RPK CENTER FOR REHAB, SPINE & PAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER-MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KISHBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:910-486-8880
Mailing Address - Street 1:2109 VALLEYGATE DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304
Mailing Address - Country:US
Mailing Address - Phone:910-486-8880
Mailing Address - Fax:910-486-8886
Practice Address - Street 1:2109 VALLEYGATE DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-486-8880
Practice Address - Fax:910-486-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015WRMedicaid
NC89015WRMedicaid