Provider Demographics
NPI:1417510447
Name:CHASE-PENA, REBECCA LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LOUISE
Last Name:CHASE-PENA
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 1:2006 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-2241
Mailing Address - Country:US
Mailing Address - Phone:386-238-9740
Mailing Address - Fax:
Practice Address - Street 1:2006 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-2241
Practice Address - Country:US
Practice Address - Phone:386-238-9740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor