Provider Demographics
NPI:1376205062
Name:RAHN, GABRIEL (DC)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:RAHN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-6221
Mailing Address - Country:US
Mailing Address - Phone:712-540-3162
Mailing Address - Fax:
Practice Address - Street 1:11507 S 42ND ST STE 105
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-6006
Practice Address - Country:US
Practice Address - Phone:712-540-3162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor