Provider Demographics
NPI:1982917068
Name:MOUSE, REBEKAH (DC)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:MOUSE
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 1:18630 E 710 RD
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-6289
Mailing Address - Country:US
Mailing Address - Phone:918-931-8733
Mailing Address - Fax:
Practice Address - Street 1:5 PLAZA SOUTH ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4750
Practice Address - Country:US
Practice Address - Phone:918-708-2563
Practice Address - Fax:918-456-3000
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor