Provider Demographics
NPI:1770516783
Name:CORSANO, RACHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:
Last Name:CORSANO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BRIDGE ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2040
Mailing Address - Country:US
Mailing Address - Phone:145-454-1700
Mailing Address - Fax:415-454-1700
Practice Address - Street 1:6 BRIDGE ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2040
Practice Address - Country:US
Practice Address - Phone:145-454-1700
Practice Address - Fax:415-454-1700
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA680482852OtherTAX ID
CADC00267000Medicare ID - Type Unspecified
CA680482852OtherTAX ID