Provider Demographics
NPI:1124229729
Name:FORNES, RACHEL (DC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:FORNES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:NEWHARTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1727 N ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3226
Mailing Address - Country:US
Mailing Address - Phone:321-784-0888
Mailing Address - Fax:
Practice Address - Street 1:1727 N ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3226
Practice Address - Country:US
Practice Address - Phone:321-784-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH0004732OtherCHIROPRACTIC LICENSE
FLCH0004732OtherCHIROPRACTIC LICENSE
FL70792AMedicare ID - Type Unspecified