Provider Demographics
NPI:1861506339
Name:TACUSALME, RABBONNI L (DC)
Entity Type:Individual
Prefix:
First Name:RABBONNI
Middle Name:L
Last Name:TACUSALME
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 1:319 JUDAH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2411
Mailing Address - Country:US
Mailing Address - Phone:415-664-2268
Mailing Address - Fax:415-664-5328
Practice Address - Street 1:319 JUDAH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2411
Practice Address - Country:US
Practice Address - Phone:415-664-2268
Practice Address - Fax:415-664-5328
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor