Provider Demographics
NPI:1578677332
Name:RIVERCHASE REHAB & WELLNESS PA
Entity Type:Organization
Organization Name:RIVERCHASE REHAB & WELLNESS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEDICHEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-393-3737
Mailing Address - Street 1:878 S DENTON TAP RD
Mailing Address - Street 2:STE 125
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4564
Mailing Address - Country:US
Mailing Address - Phone:972-393-3737
Mailing Address - Fax:972-393-4925
Practice Address - Street 1:878 S DENTON TAP RD
Practice Address - Street 2:STE 125
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4564
Practice Address - Country:US
Practice Address - Phone:972-393-3737
Practice Address - Fax:972-393-4925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5943111N00000X
TX1072528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0035JQOtherBCBS
TX00888UMedicare ID - Type Unspecified