Provider Demographics
NPI:1801065859
Name:RAHAL CHIROPRACTIC PL
Entity type:Organization
Organization Name:RAHAL CHIROPRACTIC PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-631-8585
Mailing Address - Street 1:1978 US HIGHWAY 1
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3722
Mailing Address - Country:US
Mailing Address - Phone:321-631-8585
Mailing Address - Fax:321-631-8545
Practice Address - Street 1:1978 US HIGHWAY 1
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3722
Practice Address - Country:US
Practice Address - Phone:321-631-8585
Practice Address - Fax:321-631-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8097Medicare PIN
FLU56397Medicare UPIN