Provider Demographics
NPI:1831723501
Name:KAISER, RACHEL (LAC, DACOM)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:KAISER
Suffix:
Gender:F
Credentials:LAC, DACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 W JORDAN ST STE 124
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1736
Mailing Address - Country:US
Mailing Address - Phone:850-485-5535
Mailing Address - Fax:888-490-2942
Practice Address - Street 1:14 W JORDAN ST STE 124
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1736
Practice Address - Country:US
Practice Address - Phone:850-485-5355
Practice Address - Fax:888-490-2942
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3999171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110528700Medicaid