Provider Demographics
NPI:1053311688
Name:DARDING, REBECCA L (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:L
Last Name:DARDING
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 1:432 GLENDELL LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1868
Mailing Address - Country:US
Mailing Address - Phone:618-939-9907
Mailing Address - Fax:
Practice Address - Street 1:1327 JAMIE LN
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-5569
Practice Address - Country:US
Practice Address - Phone:618-939-9969
Practice Address - Fax:618-939-9978
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP 00153253OtherRAILROAD MEDICARE
IL6732017OtherBC/BS NUMBER
IL670590OtherUHC
IL513956OtherHEALTHLINK
ILK07450Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
IL670590OtherUHC