Provider Demographics
NPI:1417089236
Name:REBISZ, BRIAN K (DC, DACRB)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
Last Name:REBISZ
Suffix:
Gender:M
Credentials:DC, DACRB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2725
Mailing Address - Country:US
Mailing Address - Phone:610-446-2828
Mailing Address - Fax:610-446-2895
Practice Address - Street 1:8420 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2725
Practice Address - Country:US
Practice Address - Phone:610-446-2828
Practice Address - Fax:610-446-2895
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002962-L111N00000X
NJMC03194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0032895000OtherIBC
0032895000OtherKHPE
188030OtherHIGHMARK BLUE SHIELD
PA1045722Medicaid
188030OtherPA. BLUE SHIELD
188030OtherHIGHMARK BLUE SHIELD
PA1045722Medicaid