MEDICARE: DR. BRIAN K REBISZ D.C., D.A.C.R.B.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC002962-L	PA
2	111N00000X	Chiropractor	MC03194	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0032895000	OTHER	IBC
2	0032895000	OTHER	KHPE
3	188030	OTHER	HIGHMARK BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	188030	OTHER	PA. BLUE SHIELD

General Provider Information

NPI Number	:	1417089236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN K REBISZ D.C., D.A.C.R.B.

Provider Business Mailing Address
First Line	:	8420 W CHESTER PIKE
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2725
Country	:	US
Telephone Number	:	610-446-2828
Fax Number	:	610-446-2895

Provider Business Practice Location Address
First Line	:	8420 W CHESTER PIKE
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2725
Country	:	US
Telephone Number	:	610-446-2828
Fax Number	:	610-446-2895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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