Provider Demographics
NPI:1134171507
Name:KARLEN, REBECCA GOULD (DC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:GOULD
Last Name:KARLEN
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 1:2918 SUTTON BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143
Mailing Address - Country:US
Mailing Address - Phone:314-781-0063
Mailing Address - Fax:314-499-9044
Practice Address - Street 1:2918 SUTTON BOULEVARD
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143
Practice Address - Country:US
Practice Address - Phone:314-781-0063
Practice Address - Fax:314-499-9044
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003017485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014064Medicare ID - Type UnspecifiedPROVIDER NUMBER