Provider Demographics
NPI:1588660971
Name:RAKITIN, PAUL I (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:I
Last Name:RAKITIN
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 1:326 E PALMETTO PARK RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5016
Mailing Address - Country:US
Mailing Address - Phone:561-367-0022
Mailing Address - Fax:561-367-0055
Practice Address - Street 1:326 E PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5016
Practice Address - Country:US
Practice Address - Phone:561-367-0022
Practice Address - Fax:561-367-0055
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL76956ZMedicare ID - Type Unspecified
U97565Medicare UPIN