Provider Demographics
NPI:1861425928
Name:REBHOLZ, CHRISTOPHER PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PAUL
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 1:690 WESTFIELD WAY STE F
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-2585
Mailing Address - Country:US
Mailing Address - Phone:262-691-0997
Mailing Address - Fax:262-875-3593
Practice Address - Street 1:690 WESTFIELD WAY STE F
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2585
Practice Address - Country:US
Practice Address - Phone:262-691-0997
Practice Address - Fax:262-875-3593
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4172-012111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38970200Medicaid
WI38970200Medicaid