Provider Demographics
NPI:1508099383
Name:REBECCA E. UPDYKE,D.C.,P.C.
Entity Type:Organization
Organization Name:REBECCA E. UPDYKE,D.C.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:UPDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC,PC
Authorized Official - Phone:303-466-6499
Mailing Address - Street 1:555 HIGHWAY 287
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7088
Mailing Address - Country:US
Mailing Address - Phone:303-466-6499
Mailing Address - Fax:303-466-6445
Practice Address - Street 1:555 HIGHWAY 287
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18523Medicare UPIN