Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHR-5940 | CO |
NPI | 1003902560 |
---|---|
Provider Name | Jeffrey John Rebarcak |
First Address | Yorkville, IL 60560-8909 |
Second Address | Yorkville, IL 60560-8909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 23/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16780 | (02) | AZ |