Provider Demographics
NPI:1417003328
Name:REBROVICH, JEREMY FRANK (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:FRANK
Last Name:REBROVICH
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 1:18336 JOPLIN ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1773
Mailing Address - Country:US
Mailing Address - Phone:763-441-0999
Mailing Address - Fax:763-441-3888
Practice Address - Street 1:18336 JOPLIN ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1773
Practice Address - Country:US
Practice Address - Phone:763-441-0999
Practice Address - Fax:763-441-3888
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU86350Medicare UPIN