Provider Demographics
NPI:1164765327
Name:THE REJUVENATION CENTER LLC
Entity Type:Organization
Organization Name:THE REJUVENATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:317-577-1990
Mailing Address - Street 1:997 E COUNTY LINE RD
Mailing Address - Street 2:SUITE M
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1075
Mailing Address - Country:US
Mailing Address - Phone:317-577-1990
Mailing Address - Fax:317-577-1993
Practice Address - Street 1:997 E COUNTY LINE RD
Practice Address - Street 2:SUITE M
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1075
Practice Address - Country:US
Practice Address - Phone:317-577-1990
Practice Address - Fax:317-577-1993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty