Provider Demographics
NPI:1710082771
Name:DR JAMES L REHBERGER PC
Entity Type:Organization
Organization Name:DR JAMES L REHBERGER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:REHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-654-4451
Mailing Address - Street 1:1000 ZSCHOKKE ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1650
Mailing Address - Country:US
Mailing Address - Phone:618-654-4451
Mailing Address - Fax:618-654-5361
Practice Address - Street 1:1000 ZSCHOKKE ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1650
Practice Address - Country:US
Practice Address - Phone:618-654-4451
Practice Address - Fax:618-654-5361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL113434OtherHEALTHLINK
IL26999OtherGROUP HEALTH PLAN
IL745007OtherFOCUS HEALTHCARE
IL0006082006OtherBLUE CROSS BLUE SHIELD
IL4263134OtherAETNA PROVIDER NUMBER
IL4400416OtherUNITED HEALTHCARE
IL207996Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
IL4263134OtherAETNA PROVIDER NUMBER
ILT36084Medicare UPIN
IL350155157Medicare ID - Type UnspecifiedRAILROAD MEDICARE