Provider Demographics
NPI:1730512286
Name:GNAS, REBECCA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN
Last Name:GNAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:DUTKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1613 S RANCH RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-1652
Mailing Address - Country:US
Mailing Address - Phone:414-510-1263
Mailing Address - Fax:
Practice Address - Street 1:530 N 108TH PL STE 100
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4253
Practice Address - Country:US
Practice Address - Phone:414-510-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4931-12111N00000X
WI4931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor