Healthcare Provider Details

I. General information

NPI: 1851454771
Provider Name (Legal Business Name): EVANSVILLE REHABILITATION, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

958 S KENMORE DR
EVANSVILLE IN
47714-7513
US

IV. Provider business mailing address

958 S KENMORE DR
EVANSVILLE IN
47714-7513
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-5003
  • Fax: 812-477-3639
Mailing address:
  • Phone: 812-477-5003
  • Fax: 812-477-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: JAY D ROHLEDER
Title or Position: MANAGING PARTNER
Credential: D.C.
Phone: 812-477-5003