Provider Demographics
NPI:1215011010
Name:PANGEMANAN, REBECCA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN
Last Name:PANGEMANAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:MEALIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1004 DEWEY DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-1761
Mailing Address - Country:US
Mailing Address - Phone:502-839-7171
Mailing Address - Fax:502-839-4441
Practice Address - Street 1:1004 DEWEY DR STE C
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1761
Practice Address - Country:US
Practice Address - Phone:502-839-7171
Practice Address - Fax:502-839-4441
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003697Medicaid