Provider Demographics
NPI:1932150745
Name:ORTMAN, REBECCA I (DC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:I
Last Name:ORTMAN
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:PO BOX 955
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-0955
Mailing Address - Country:US
Mailing Address - Phone:360-376-2100
Mailing Address - Fax:360-376-6255
Practice Address - Street 1:441 N BEACH RD
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-8927
Practice Address - Country:US
Practice Address - Phone:360-376-2100
Practice Address - Fax:360-376-6255
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033633111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB39876Medicare ID - Type Unspecified
WAU12467Medicare UPIN