Provider Demographics
NPI:1023024122
Name:SPACKE, REBECCA S (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:S
Last Name:SPACKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 OVERSEAS HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2235
Mailing Address - Country:US
Mailing Address - Phone:305-289-9355
Mailing Address - Fax:305-289-9332
Practice Address - Street 1:2901 OVERSEAS HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2235
Practice Address - Country:US
Practice Address - Phone:305-289-9355
Practice Address - Fax:305-289-9332
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor