Provider Demographics
NPI:1295002228
Name:REBECCA A NOREN DC LLC
Entity Type:Organization
Organization Name:REBECCA A NOREN DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-984-1111
Mailing Address - Street 1:1360 S WADSWORTH BLVD
Mailing Address - Street 2:103
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-5415
Mailing Address - Country:US
Mailing Address - Phone:303-984-1111
Mailing Address - Fax:
Practice Address - Street 1:1360 S WADSWORTH BLVD
Practice Address - Street 2:103
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5415
Practice Address - Country:US
Practice Address - Phone:303-984-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20011049923261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service