Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC009471 | PA |
N | 111NN1001X | Nutrition | DC009471 | PA |
NPI | 1053556464 |
---|---|
Provider Name | Dr. Paul Raymond Rebholz |
First Address | Beaver Falls, PA 15010-8533 |
Second Address | Cranberry Township, PA 16066-6442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2008 |
Last Update Date | 14/12/2008 |