Provider Demographics
NPI:1851756928
Name:KENTREBLINGDC
Entity Type:Organization
Organization Name:KENTREBLINGDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:EBLING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-782-2066
Mailing Address - Street 1:11 SE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-8439
Mailing Address - Country:US
Mailing Address - Phone:954-782-2066
Mailing Address - Fax:954-782-2066
Practice Address - Street 1:11 SE 8TH ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-8439
Practice Address - Country:US
Practice Address - Phone:954-782-2066
Practice Address - Fax:954-782-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382273700Medicaid
FL382273700Medicaid
FLU12695Medicare UPIN