Provider Demographics
NPI:1245687441
Name:EGGAR, REBEKAH (LAC)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:EGGAR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 TIMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-4033
Mailing Address - Country:US
Mailing Address - Phone:630-222-5506
Mailing Address - Fax:
Practice Address - Street 1:110 GLANCY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2326
Practice Address - Country:US
Practice Address - Phone:615-868-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN302171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist