Provider Demographics
NPI:1992742183
Name:PUGH, REBECCA ANNE (DC)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANNE
Last Name:PUGH
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 1:5107 MARYLAND WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7565
Mailing Address - Country:US
Mailing Address - Phone:615-390-8279
Mailing Address - Fax:
Practice Address - Street 1:5107 MARYLAND WAY
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7565
Practice Address - Country:US
Practice Address - Phone:615-390-8279
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU94890Medicare UPIN
TN3671205Medicare ID - Type Unspecified