Provider Demographics
NPI:1063586881
Name:REBISZ, KALTHEEN SUE ANN (DC,DACRB)
Entity type:Individual
Prefix:DR
First Name:KALTHEEN
Middle Name:SUE ANN
Last Name:REBISZ
Suffix:
Gender:F
Credentials:DC,DACRB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1600
Mailing Address - Country:US
Mailing Address - Phone:973-772-0411
Mailing Address - Fax:973-772-4934
Practice Address - Street 1:430 MIDLAND AVENUE
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-1600
Practice Address - Country:US
Practice Address - Phone:973-772-0411
Practice Address - Fax:973-772-4934
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00357600111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ470014Medicare ID - Type Unspecified