Healthcare Provider Details

I. General information

NPI: 1740599034
Provider Name (Legal Business Name): REBECCA LLACA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2765 N SCOTTSDALE RD SUITE 108
SCOTTSDALE AZ
85257-1335
US

IV. Provider business mailing address

2765 N SCOTTSDALE RD SUITE 108
SCOTTSDALE AZ
85257-1335
US

V. Phone/Fax

Practice location:
  • Phone: 480-990-1818
  • Fax:
Mailing address:
  • Phone: 480-652-4788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8126
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: