Provider Demographics
NPI:1770968935
Name:FIDLER, REBECCA J (DC)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:FIDLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:JANE
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:675 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-3246
Mailing Address - Country:US
Mailing Address - Phone:435-915-6032
Mailing Address - Fax:
Practice Address - Street 1:675 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3246
Practice Address - Country:US
Practice Address - Phone:435-915-6032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9452644-1202111N00000X
CA33291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor