MEDICARE: RAFAEL FOSS 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	CH9389	FL
2	111N00000X	Chiropractor	011303	NY

General Provider Information

NPI Number	:	1538257472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL FOSS DC

Provider Business Mailing Address
First Line	:	500 SCOTIA DR APT 303
Second Line	:
City	:	HYPOLUXO
State	:	FL
Zip	:	33462-7013
Country	:	US
Telephone Number	:	347-582-1869
Fax Number	:

Provider Business Practice Location Address
First Line	:	4212 NORTHLAKE BLVD
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6252
Country	:	US
Telephone Number	:	561-627-2821
Fax Number	:	561-627-0542

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	06/22/2020

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