Provider Demographics
NPI:1982338950
Name:ANDERSON, REBECCA DANAE (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:DANAE
Last Name:ANDERSON
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 1:120 RUE CANARD
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-4056
Mailing Address - Country:US
Mailing Address - Phone:509-855-3502
Mailing Address - Fax:
Practice Address - Street 1:9 STARBRUSH CIR STE 201
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7246
Practice Address - Country:US
Practice Address - Phone:985-259-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1948111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor