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General NPI Number Information
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NPI Number | 1215940119
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Entity Type | Organization
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Legal Business Name | RAFOOL PC
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 351 RUSCHE ST
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City | CREVE COEUR
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State | IL
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Zip | 61610-3185
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Country | US
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Telephone | 309-694-3565
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Fax | 309-694-3652
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Provider Business Mailing Address
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Address Line | 351 RUSCHE ST
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City | CREVE COEUR
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State | IL
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Zip | 61610-3185
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Country | US
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Telephone | 309-694-3565
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Fax | 309-694-3652
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN E RAFOOL
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Credential | D.C.
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Telephone | 309-694-3565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38-006151
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License Number State | IL
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