Provider Demographics
NPI:1821313297
Name:REBECCA GOULD DC PC
Entity type:Organization
Organization Name:REBECCA GOULD DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:GOULD
Authorized Official - Last Name:KARLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-781-0063
Mailing Address - Street 1:2918 SUTTON BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-3012
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:63143-3012
Practice Address - Country:US
Practice Address - Phone:314-781-0063
Practice Address - Fax:314-499-9044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
MO2003017485261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty