Provider Demographics
NPI:1144819699
Name:STREET, REBECCA (DC)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:STREET
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 1:6321 N KEYSTONE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2156
Mailing Address - Country:US
Mailing Address - Phone:317-257-2225
Mailing Address - Fax:317-257-0646
Practice Address - Street 1:6321 N KEYSTONE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2156
Practice Address - Country:US
Practice Address - Phone:317-257-2225
Practice Address - Fax:317-257-0646
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003210A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor