Provider Demographics
NPI:1790810497
Name:WRIGHT, REBECCA PULLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:PULLEN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:NICOLE
Other - Last Name:PULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:212 W ROUTE 38 STE 480
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3259
Mailing Address - Country:US
Mailing Address - Phone:856-235-2240
Mailing Address - Fax:856-235-7003
Practice Address - Street 1:212 W ROUTE 38 STE 480
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3259
Practice Address - Country:US
Practice Address - Phone:856-235-2240
Practice Address - Fax:856-235-7003
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00638200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ186403YN8Medicare PIN