Highland Park Chiropractic Center LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

MC03194 Issued in PA

Legal business name

HIGHLAND PARK CHIROPRACTIC CENTER LLC

Practice address

8420 W Chester Pike
Upper Darby, PA 19082-2725

Phone

(610) 446-2828

NPI assigned

Mar 16, 2007

Last updated

Oct 18, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brian Rebisz, D.C.,D.A.C.R.B.NPI 1417089236

Title

Owner

Phone

(610) 446-2828

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brian K Rebisz, D.C., D.A.C.R.B.

  • Chiropractor
  • Upper Darby, PA
  • NPI 1417089236
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318896000000",
    "number": "1245364512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8420 W CHESTER PIKE",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190822725",
            "telephone_number": "610-446-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8420 W CHESTER PIKE",
            "city": "UPPER DARBY",
            "state": "PA",
            "postal_code": "190822725",
            "telephone_number": "610-446-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGHLAND PARK CHIROPRACTIC CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2011-10-18",
        "status": "A",
        "authorized_official_last_name": "REBISZ",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-446-2828",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C.,D.A.C.R.B."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC002962-L",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "MC03194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBC",
            "identifier": "0032895000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA. BLUE SHIELD HIGHMARK",
            "identifier": "188030",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1045722",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KHPE",
            "identifier": "0032895000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Upper Darby, PA
• Providers in Upper Darby, PA by specialty
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.