Provider Demographics
NPI:1083314546
Name:BORON-TROTTER, REBEKAH (DC)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:BORON-TROTTER
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 1:1157 MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4399
Mailing Address - Country:US
Mailing Address - Phone:209-663-1498
Mailing Address - Fax:
Practice Address - Street 1:1157 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4399
Practice Address - Country:US
Practice Address - Phone:209-663-1498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor