Provider Demographics
NPI:1134458474
Name:ROSENTHAL, REBECCA ANN (DC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:202 SUMMIT STREET
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036
Mailing Address - Country:US
Mailing Address - Phone:815-776-0595
Mailing Address - Fax:815-776-0595
Practice Address - Street 1:202 SUMMIT STREET
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036
Practice Address - Country:US
Practice Address - Phone:815-776-0595
Practice Address - Fax:815-776-0595
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007243111N00000X
WI4551012111N00000X
IL038011927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor