Provider Demographics
NPI:1215117189
Name:BARDALL, RACHELLE LEE (DC)
Entity type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:LEE
Last Name:BARDALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-2201
Mailing Address - Country:US
Mailing Address - Phone:330-682-9444
Mailing Address - Fax:330-683-7306
Practice Address - Street 1:531 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-2201
Practice Address - Country:US
Practice Address - Phone:330-682-9444
Practice Address - Fax:330-683-7306
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0802452Medicare PIN