Healthcare Provider Details

I. General information

NPI: 1053852764
Provider Name (Legal Business Name): STUDIO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

892 S FRONTENAC ST
AURORA IL
60504-3165
US

IV. Provider business mailing address

892 S FRONTENAC ST
AURORA IL
60504-3167
US

V. Phone/Fax

Practice location:
  • Phone: 480-823-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038.012864
License Number StateIL

VIII. Authorized Official

Name: JEFFREY REBARCAK
Title or Position: OWNER
Credential:
Phone: 480-302-1102