Provider Demographics
NPI:1366735458
Name:SASAK, REBECCA A (LAC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:A
Last Name:SASAK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 INDIAN BOUNDARY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-1511
Mailing Address - Country:US
Mailing Address - Phone:219-728-1891
Mailing Address - Fax:219-427-0571
Practice Address - Street 1:368 INDIAN BOUNDARY RD
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-1511
Practice Address - Country:US
Practice Address - Phone:219-728-1891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000109A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist