Healthcare Provider Details

I. General information

NPI: 1164765327
Provider Name (Legal Business Name): THE REJUVENATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 E COUNTY LINE RD SUITE M
GREENWOOD IN
46143-1075
US

IV. Provider business mailing address

997 E COUNTY LINE RD SUITE M
GREENWOOD IN
46143-1075
US

V. Phone/Fax

Practice location:
  • Phone: 317-577-1990
  • Fax: 317-577-1993
Mailing address:
  • Phone: 317-577-1990
  • Fax: 317-577-1993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW J BAUER
Title or Position: OWNER
Credential: D.O.
Phone: 317-577-1990