Provider Demographics
NPI:1952466542
Name:PAULY, REBECCA A (BS DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:A
Last Name:PAULY
Suffix:
Gender:F
Credentials:BS DC
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS DC
Mailing Address - Street 1:1405 78TH ST STE 100
Mailing Address - Street 2:PO BOX 93
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-9723
Mailing Address - Country:US
Mailing Address - Phone:952-443-3710
Mailing Address - Fax:952-443-3761
Practice Address - Street 1:1405 78TH ST STE 100
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-9723
Practice Address - Country:US
Practice Address - Phone:952-443-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN378615300Medicaid
V03180Medicare UPIN
MN378615300Medicaid