Provider Demographics
NPI:1174535058
Name:KNIGHT, REBECCA ANN (DC)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:KNIGHT
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 1:3200 E LOS ANGELES AVE STE 28
Mailing Address - Street 2:SUITE 28
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3971
Mailing Address - Country:US
Mailing Address - Phone:805-581-2310
Mailing Address - Fax:
Practice Address - Street 1:3200 E LOS ANGELES AVE STE 28
Practice Address - Street 2:SUITE 28
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3971
Practice Address - Country:US
Practice Address - Phone:805-581-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7020111N00000X
CADC30901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU66963Medicare UPIN