Provider Demographics
NPI:1245783521
Name:WILLIAMS, REBECCA (DC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:DAWN
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:958 S LOCHSA ST STE 307
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-8358
Mailing Address - Country:US
Mailing Address - Phone:208-213-1234
Mailing Address - Fax:208-413-6220
Practice Address - Street 1:958 S LOCHSA ST STE 307
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-8358
Practice Address - Country:US
Practice Address - Phone:208-213-1234
Practice Address - Fax:208-413-6220
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2025-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8371385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor