=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689786915
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VINCENT M. RAHAL D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 01/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1954 US HIGHWAY 1 SUITE 115
-----------------------------------------------------
City | ROCKLEDGE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32955-3761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-631-8585
-----------------------------------------------------
Fax | 321-631-8545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1954 US HIGHWAY 1 SUITE 115
-----------------------------------------------------
City | ROCKLEDGE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32955-3761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-631-8585
-----------------------------------------------------
Fax | 321-631-8545
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | CH0006710
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------