Provider Demographics
NPI:1053556464
Name:REBHOLZ, PAUL RAYMOND (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RAYMOND
Last Name:REBHOLZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 CONCORD CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-8533
Mailing Address - Country:US
Mailing Address - Phone:412-592-4423
Mailing Address - Fax:412-548-3794
Practice Address - Street 1:213 EXECUTIVE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6442
Practice Address - Country:US
Practice Address - Phone:724-742-1777
Practice Address - Fax:724-742-1780
Is Sole Proprietor?:No
Enumeration Date:2008-12-14
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009471111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition