Provider Demographics
NPI:1386737278
Name:CONSOLE, RACHEL (DC)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:CONSOLE
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 1:228 NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4829
Mailing Address - Country:US
Mailing Address - Phone:203-878-3445
Mailing Address - Fax:203-876-0937
Practice Address - Street 1:228 NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4829
Practice Address - Country:US
Practice Address - Phone:203-878-3445
Practice Address - Fax:203-876-0937
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU79552Medicare UPIN