Provider Demographics
NPI:1215025655
Name:UPDYKE, REBECCA ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:UPDYKE
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 1:555 HWY 287
Mailing Address - Street 2:UNIT A-1
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020
Mailing Address - Country:US
Mailing Address - Phone:303-466-6499
Mailing Address - Fax:303-466-6445
Practice Address - Street 1:555 US HIGHWAY 287
Practice Address - Street 2:UNIT A1
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7088
Practice Address - Country:US
Practice Address - Phone:303-466-6499
Practice Address - Fax:303-466-6445
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2243OtherCHIROPRACTIC LISCENSE NO.
CO2243OtherCHIROPRACTIC LISCENSE NO.