Individual
REBECCA J SUPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
410 DALY AVE, WISCONSIN RAPIDS, WI 54494-4744
(715) 423-5050
(715) 423-5086
Mailing address
410 DALY AVE, WISCONSIN RAPIDS, WI 54494-4744
(715) 423-5050
(715) 423-5086
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2899012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38875000
—
WI
Enumeration date
01/20/2006
Last updated
07/08/2007
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