Healthcare Provider Details

I. General information

NPI: 1134171507
Provider Name (Legal Business Name): REBECCA GOULD KARLEN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/28/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 SUTTON BOULEVARD
MAPLEWOOD MO
63143
US

IV. Provider business mailing address

2918 SUTTON BOULEVARD
MAPLEWOOD MO
63143
US

V. Phone/Fax

Practice location:
  • Phone: 314-781-0063
  • Fax: 314-499-9044
Mailing address:
  • Phone: 314-781-0063
  • Fax: 314-499-9044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2003017485
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: