Provider Demographics
NPI:1912762311
Name:REBOUND CHIROPRACTIC AND SPORTS CLINICS
Entity Type:Organization
Organization Name:REBOUND CHIROPRACTIC AND SPORTS CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-279-7668
Mailing Address - Street 1:2045 UNIVERSITY BLVD E STE 202
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-4137
Mailing Address - Country:US
Mailing Address - Phone:301-723-7727
Mailing Address - Fax:240-261-7229
Practice Address - Street 1:2045 UNIVERSITY BLVD E STE 202
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4137
Practice Address - Country:US
Practice Address - Phone:301-723-7727
Practice Address - Fax:240-261-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty