MEDICARE: DR. RAFAEL M FABIAN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	383	PR

General Provider Information

NPI Number	:	1275578627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAFAEL M FABIAN DC

Provider Business Mailing Address
First Line	:	730 AVE PONCE DE LEON
Second Line	:	SUITE 3
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4509
Country	:	US
Telephone Number	:	787-758-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 AVE PONCE DE LEON
Second Line	:	SUITE 3
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4509
Country	:	US
Telephone Number	:	787-758-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/08/2007

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