Provider Demographics
NPI:1003239989
Name:RACKOVAN, ANDREW (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:RACKOVAN
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 1:2621 RAYMOND DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4872
Mailing Address - Country:US
Mailing Address - Phone:636-946-2244
Mailing Address - Fax:636-946-6975
Practice Address - Street 1:2621 RAYMOND DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4872
Practice Address - Country:US
Practice Address - Phone:636-946-2244
Practice Address - Fax:636-946-6975
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014002027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor