Provider Demographics
NPI:1255438826
Name:CAVANNA, RACHEL COATES (DC)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:COATES
Last Name:CAVANNA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:MAY
Other - Last Name:COATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:210 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2333
Mailing Address - Country:US
Mailing Address - Phone:860-388-9390
Mailing Address - Fax:860-388-9391
Practice Address - Street 1:210 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2333
Practice Address - Country:US
Practice Address - Phone:860-388-9390
Practice Address - Fax:860-388-9391
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY45878Medicare UPIN