Provider Demographics
NPI:1215076484
Name:RABIN, EDWIN BRUCE (DC)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:BRUCE
Last Name:RABIN
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 1:370 OCEAN PKWY APT 11G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4623
Mailing Address - Country:US
Mailing Address - Phone:208-890-6010
Mailing Address - Fax:
Practice Address - Street 1:1080 W BOISE AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3502
Practice Address - Country:US
Practice Address - Phone:208-388-1895
Practice Address - Fax:208-388-1996
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH007217111N00000X
NYX012371111N00000X
TXTX10818111N00000X
IL038.011271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU75900Medicare UPIN