Provider Demographics
NPI:1851454771
Name:EVANSVILLE REHABILITATION, P.C.
Entity Type:Organization
Organization Name:EVANSVILLE REHABILITATION, P.C.
Other - Org Name:HAMILTON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROHLEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-477-5003
Mailing Address - Street 1:958 S KENMORE DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-7513
Mailing Address - Country:US
Mailing Address - Phone:812-477-5003
Mailing Address - Fax:812-477-3639
Practice Address - Street 1:958 S KENMORE DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-7513
Practice Address - Country:US
Practice Address - Phone:812-477-5003
Practice Address - Fax:812-477-3639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6369800001Medicare NSC
IN636810Medicare ID - Type UnspecifiedPROVIDER NUMBER