Provider Demographics
NPI:1518153345
Name:ROSS, REBECCA K (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:K
Last Name:ROSS
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 1:550 SILVER LEAF DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8330
Mailing Address - Country:US
Mailing Address - Phone:815-514-8513
Mailing Address - Fax:
Practice Address - Street 1:550 SILVER LEAF DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8330
Practice Address - Country:US
Practice Address - Phone:815-514-8513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.010966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor