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General NPI Number Information
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NPI Number | 1316484405
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Entity Type | Organization
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Legal Business Name | REBEL PERFORMANCE CHIROPRACTIC
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 600 IRON CITY DR
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City | PITTSBURGH
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State | PA
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Zip | 15205-4349
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Country | US
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Telephone | 412-552-3416
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Fax | 412-250-0090
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Provider Business Mailing Address
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Address Line | 600 IRON CITY DR
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City | PITTSBURGH
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State | PA
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Zip | 15205-4349
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Country | US
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Telephone | 412-552-3416
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Fax | 412-250-0090
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | NATHAN DAVID CRAIN
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Credential | D.C.
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Telephone | 412-552-3416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC011216
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License Number State | PA
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