Provider Demographics
NPI:1437422607
Name:REBISZ CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:REBISZ CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:REBISZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PACRB
Authorized Official - Phone:973-772-0411
Mailing Address - Street 1:430 MIDLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026
Mailing Address - Country:US
Mailing Address - Phone:973-772-0411
Mailing Address - Fax:973-772-4934
Practice Address - Street 1:430 MIDLAND AVE.
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026
Practice Address - Country:US
Practice Address - Phone:973-772-0411
Practice Address - Fax:973-772-4934
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REBISZ CHIROPRACTIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00357600111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8480508Medicaid