Provider Demographics
NPI:1114973757
Name:REHRIG, DENNIS TODD (DC)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:TODD
Last Name:REHRIG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E STATE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3434
Mailing Address - Country:US
Mailing Address - Phone:610-566-9040
Mailing Address - Fax:610-566-9038
Practice Address - Street 1:200 E STATE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3434
Practice Address - Country:US
Practice Address - Phone:610-566-9040
Practice Address - Fax:610-566-9038
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001694L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4396993OtherAETNA PPO ID
PA0032840000OtherHMO ID
PA2357837000OtherGROUP HMO ID
PA5133326OtherAETNA GROUP ID
PA51864OtherAETNA HMO ID
PA2357837000OtherGROUP HMO ID
PA4396993OtherAETNA PPO ID
PA089507Medicare ID - Type Unspecified