Provider Demographics
NPI:1073677928
Name:RAICH, MITCHELL L (DC)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:L
Last Name:RAICH
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 1:25012 104TH AVE SE
Mailing Address - Street 2:STE E
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-2821
Mailing Address - Country:US
Mailing Address - Phone:253-854-1233
Mailing Address - Fax:253-854-1297
Practice Address - Street 1:25012 104TH AVE SE
Practice Address - Street 2:STE E
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-2821
Practice Address - Country:US
Practice Address - Phone:253-854-1233
Practice Address - Fax:253-854-1297
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0188454OtherL & I PROVIDER NUMBER
WA666521OtherUNITED HEALTHPLAN
WA6777251OtherCIGNA PROVIDER NUMBER
WA3690368OtherAETNA PROVIDER NUMBER
WA5735386OtherFIRST HEALTH NETWORK
WA8858035Medicare ID - Type Unspecified
WA5735386OtherFIRST HEALTH NETWORK