Healthcare Provider Details

I. General information

NPI: 1770516783
Provider Name (Legal Business Name): RACHAEL CORSANO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BRIDGE ST SUITE 2A
SAN ANSELMO CA
94960-2040
US

IV. Provider business mailing address

6 BRIDGE ST SUITE 2A
SAN ANSELMO CA
94960-2040
US

V. Phone/Fax

Practice location:
  • Phone: 145-454-1700
  • Fax: 415-454-1700
Mailing address:
  • Phone: 145-454-1700
  • Fax: 415-454-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC26700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: