Organization
HIGHLAND PARK CHIROPRACTIC CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN REBISZ D.C.,D.A.C.R.B. (OWNER)
(610) 446-2828
Entity
Organization
Contact information
Practice address
8420 W CHESTER PIKE, UPPER DARBY, PA 19082-2725
(610) 446-2828
Mailing address
8420 W CHESTER PIKE, UPPER DARBY, PA 19082-2725
(610) 446-2828
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
DC002962-L
PA
111N00000X
Chiropractor
Primary
MC03194
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0032895000
IBC
—
05
—
1045722
—
PA
01
—
188030
PA. BLUE SHIELD HIGHMARK
—
Enumeration date
03/16/2007
Last updated
10/18/2011
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