Provider Demographics
NPI:1992884498
Name:REBMANN, RONALD MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MICHAEL
Last Name:REBMANN
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 1:736 FLORSHEIM DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3704
Mailing Address - Country:US
Mailing Address - Phone:847-680-3900
Mailing Address - Fax:847-680-2026
Practice Address - Street 1:736 FLORSHEIM DR
Practice Address - Street 2:SUITE 12
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3704
Practice Address - Country:US
Practice Address - Phone:847-680-3900
Practice Address - Fax:847-680-2026
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005127111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4922462OtherBLUE CROSS BLUE SHIELD
IL597300Medicare ID - Type Unspecified