Rejuv Integrative Medical Practice Shawn C Snider

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

036.110856 Issued in IL

Legal business name

REJUV INTEGRATIVE MEDICAL PRACTICE SHAWN C SNIDER

Practice address

405 N Hershey Rd
Bloomington, IL 61704-3527

Phone

(309) 622-3002

Fax

(309) 263-4611

NPI assigned

May 17, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Shawn Christopher Snider, CNP

Title

Owner

Phone

(309) 622-3002

Specialties & licenses 1

Addresses

Other names 1

• Liferx Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337212800000",
    "number": "1104186667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 N HERSHEY RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043527",
            "telephone_number": "309-622-3002",
            "fax_number": "309-263-4611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 N HERSHEY RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043527",
            "telephone_number": "309-622-3002",
            "fax_number": "309-263-4611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REJUV INTEGRATIVE MEDICAL PRACTICE SHAWN C SNIDER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-17",
        "last_updated": "2012-05-17",
        "status": "A",
        "authorized_official_last_name": "SNIDER",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-622-3002",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "IL",
            "license": "036.110856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liferx",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Krista M Reichert, LCSW RPT-S
• Nicholas Reichmuth
• Brian J Reilly, D.P.M.
• Benjamin Reinert, PT, DPT
• Rejuv Central PC
• Rejuvanation
• Revival Road Therapy PLLC
• RHC Investments, LLC - Bloomington Fox Creek Operations Series
• Kimberly Kelleher Rhoda, OT
• RHP Investments, LLC - Bloomington Towanda Operations Series

• Health Service Clinic/Center in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Health Service Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.