Healthcare Provider Details

I. General information

NPI: 1770401853
Provider Name (Legal Business Name): REBECCA VONBERGEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W STATE ST
ITHACA NY
14850-5222
US

IV. Provider business mailing address

520 W STATE ST
ITHACA NY
14850-5222
US

V. Phone/Fax

Practice location:
  • Phone: 607-277-0101
  • Fax: 607-277-0101
Mailing address:
  • Phone: 607-277-0101
  • Fax: 607-277-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA VONBERGEN
Title or Position: OWNER
Credential: DC
Phone: 607-277-0101