Provider Demographics
NPI:1104136589
Name:FABRY, REBECCA L (DC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:FABRY
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 1:161 S SUGAR ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-1636
Mailing Address - Country:US
Mailing Address - Phone:740-695-3004
Mailing Address - Fax:740-695-3009
Practice Address - Street 1:161 S SUGAR ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1636
Practice Address - Country:US
Practice Address - Phone:740-695-3004
Practice Address - Fax:740-695-3009
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4053111N00000X
WV915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor