Provider Demographics
NPI:1689786915
Name:RAHAL, VINCENT M (DC)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:M
Last Name:RAHAL
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 1:1954 US HIGHWAY 1
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3761
Mailing Address - Country:US
Mailing Address - Phone:321-631-8585
Mailing Address - Fax:321-631-8545
Practice Address - Street 1:1954 US HIGHWAY 1
Practice Address - Street 2:SUITE 115
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3761
Practice Address - Country:US
Practice Address - Phone:321-631-8585
Practice Address - Fax:321-631-8545
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006710111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55299OtherBLUE CROSS / BLUE SHIELD
U56397Medicare UPIN
FL55299OtherBLUE CROSS / BLUE SHIELD