Provider Demographics
NPI:1457407116
Name:REBROVICH AND WHALEN CHIROPRACTIC, LTD.
Entity type:Organization
Organization Name:REBROVICH AND WHALEN CHIROPRACTIC, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:REBROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-441-0999
Mailing Address - Street 1:18336 JOPLIN ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1773
Mailing Address - Country:US
Mailing Address - Phone:763-441-0999
Mailing Address - Fax:763-441-3888
Practice Address - Street 1:18336 JOPLIN ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1773
Practice Address - Country:US
Practice Address - Phone:763-441-0999
Practice Address - Fax:763-441-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN49D93IDOtherBCBS
MN49D93IDOtherBCBS