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General NPI Number Information
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NPI Number | 1700543915
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Entity Type | Organization
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Legal Business Name | HYBRID PERFORMANCE HEALTH LLC
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Dates
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Enumeration Date | 11/22/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 11507 S 42ND ST STE 105
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City | BELLEVUE
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State | NE
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Zip | 68123-6006
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Country | US
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Telephone | 712-540-3162
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Fax |
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Provider Business Mailing Address
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Address Line | 11507 S 42ND ST STE 105
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City | BELLEVUE
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State | NE
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Zip | 68123-6006
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Country | US
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Telephone | 712-540-3162
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Fax |
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Authorized Official
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Title or Position | CHIRPRACTOR/OWNER
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Name | GABRIEL S RAHN
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Credential | DC
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Telephone | 712-540-3162
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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 |
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License Number State |
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