Provider Demographics
NPI:1639370968
Name:VACCO, RAPHAEL R (DC)
Entity Type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:R
Last Name:VACCO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RALPH
Other - Middle Name:ROBERT
Other - Last Name:VACCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:41877 ENTERPRISE CIR N
Mailing Address - Street 2:SUITE 200-E
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5656
Mailing Address - Country:US
Mailing Address - Phone:951-296-5880
Mailing Address - Fax:951-296-5880
Practice Address - Street 1:41877 ENTERPRISE CIR N
Practice Address - Street 2:SUITE 200-E
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5656
Practice Address - Country:US
Practice Address - Phone:951-296-5880
Practice Address - Fax:951-296-5880
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC21542OtherSTATE LICENSE NUMBER