Provider Demographics
NPI:1306973730
Name:REHANEK, TODD J (DC)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:J
Last Name:REHANEK
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 1:3645 SAVIERS ROAD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033
Mailing Address - Country:US
Mailing Address - Phone:805-483-0607
Mailing Address - Fax:805-832-6868
Practice Address - Street 1:3645 SAVIERS ROAD
Practice Address - Street 2:SUITE #1
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033
Practice Address - Country:US
Practice Address - Phone:805-483-0607
Practice Address - Fax:805-832-6868
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0239600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU60235Medicare UPIN
U60235Medicare UPIN
DC23960Medicare ID - Type Unspecified