Provider Demographics
NPI:1538257472
Name:FOSS, RAFAEL (DC)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:FOSS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SCOTIA DR APT 303
Mailing Address - Street 2:
Mailing Address - City:HYPOLUXO
Mailing Address - State:FL
Mailing Address - Zip Code:33462-7013
Mailing Address - Country:US
Mailing Address - Phone:347-582-1869
Mailing Address - Fax:
Practice Address - Street 1:4212 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6252
Practice Address - Country:US
Practice Address - Phone:561-627-2821
Practice Address - Fax:561-627-0542
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9389111N00000X
NY011303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor