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General NPI Number Information
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NPI Number | 1871190363
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Entity Type | Organization
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Legal Business Name | REBEL MEDICAL GROUP LLC
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 2920 MARIETTA HWY STE 102
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City | CANTON
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State | GA
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Zip | 30114-8207
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Country | US
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Telephone | 714-310-5499
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Fax | 678-890-2090
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Provider Business Mailing Address
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Address Line | 2920 MARIETTA HWY STE 102
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City | CANTON
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State | GA
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Zip | 30114-8207
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Country | US
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Telephone | 714-310-5499
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Fax | 678-890-2090
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. DANIEL TURNER
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Credential | DC
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Telephone | 770-580-0123
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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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