Provider Demographics
NPI:1093399321
Name:KUZICHEV, REBEKKA (DC)
Entity type:Individual
Prefix:
First Name:REBEKKA
Middle Name:
Last Name:KUZICHEV
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 1:15325 N NEWPORT HWY
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-9592
Mailing Address - Country:US
Mailing Address - Phone:509-315-8166
Mailing Address - Fax:509-315-8308
Practice Address - Street 1:15325 N NEWPORT HWY
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:WA
Practice Address - Zip Code:99021-9592
Practice Address - Country:US
Practice Address - Phone:509-315-8166
Practice Address - Fax:509-315-8308
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61164759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA