Provider Demographics
NPI:1083862007
Name:GEMPERLE, REBECCA CHRISTY (LAC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CHRISTY
Last Name:GEMPERLE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2654 W MEDILL AVE
Mailing Address - Street 2:#311
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3076
Mailing Address - Country:US
Mailing Address - Phone:630-728-1920
Mailing Address - Fax:
Practice Address - Street 1:2112 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6405
Practice Address - Country:US
Practice Address - Phone:773-880-9939
Practice Address - Fax:773-880-9916
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000752171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist