Provider Demographics
NPI:1225115280
Name:CHRESTMAN, REBECCA E (DOM & LAC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:E
Last Name:CHRESTMAN
Suffix:
Gender:F
Credentials:DOM & LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E WOODHURST DR
Mailing Address - Street 2:R300
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4261
Mailing Address - Country:US
Mailing Address - Phone:417-877-1300
Mailing Address - Fax:
Practice Address - Street 1:1200 E WOODHURST DR
Practice Address - Street 2:R300
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4261
Practice Address - Country:US
Practice Address - Phone:417-877-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM806171100000X
MO2010000775171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist