Provider Demographics
NPI:1932160439
Name:RAMBOER, REBECCA ANN (DC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:RAMBOER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5896 DIXIE HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346
Mailing Address - Country:US
Mailing Address - Phone:248-623-6107
Mailing Address - Fax:248-623-6443
Practice Address - Street 1:5896 DIXIE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:248-623-6107
Practice Address - Fax:248-623-6443
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRS008207111N00000X
MIRR008207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F355360OtherBLUE CROSS BLUE SHIELD
U85153Medicare UPIN
N30330001Medicare ID - Type Unspecified