Provider Demographics
NPI:1083791602
Name:RAEF, KEVIN E (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:E
Last Name:RAEF
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 1:402 15TH ST
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-3839
Mailing Address - Country:US
Mailing Address - Phone:806-655-1108
Mailing Address - Fax:806-655-1037
Practice Address - Street 1:402 15TH ST
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-3839
Practice Address - Country:US
Practice Address - Phone:806-655-1108
Practice Address - Fax:806-655-1037
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001206401Medicaid
TXT15411Medicare UPIN
TX601289Medicare ID - Type Unspecified