MEDICARE: REBELUTION CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1902495070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBELUTION CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	4800 WHITESBURG DR SW # 30-192
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35802-1698
Country	:	US
Telephone Number	:	408-805-0570
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 WHITESBURG DR SW # 30-192
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35802-1698
Country	:	US
Telephone Number	:	408-805-0570
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MOLLIE A ROOD
Credential	:	DC
Telephone Number	:	408-805-0570

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	01/13/2021

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Directions to “REBELUTION CHIROPRACTIC LLC ” Practice Location

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