Provider Demographics
NPI:1801819057
Name:REBOUND CHIROPRACTIC HEALTH CENTER LTD
Entity Type:Organization
Organization Name:REBOUND CHIROPRACTIC HEALTH CENTER LTD
Other - Org Name:REBOUND CHIROPRACTIC & ACUPUNCTURE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-873-8701
Mailing Address - Street 1:11790 JEFFERSON AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606
Mailing Address - Country:US
Mailing Address - Phone:757-873-8701
Mailing Address - Fax:757-873-6737
Practice Address - Street 1:11790 JEFFERSON AVE
Practice Address - Street 2:#205
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606
Practice Address - Country:US
Practice Address - Phone:757-873-8701
Practice Address - Fax:757-873-6737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000671111N00000X, 171100000X
VA0104556169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA274506OtherANTHEM BCBS
990010356OtherRRMM
VAT21639Medicare UPIN
VA274506OtherANTHEM BCBS