Provider Demographics
NPI:1093798019
Name:RAUCH, JEFFREY KARL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KARL
Last Name:RAUCH
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 1:38904 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2890
Mailing Address - Country:US
Mailing Address - Phone:586-978-8240
Mailing Address - Fax:586-978-1417
Practice Address - Street 1:38904 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2890
Practice Address - Country:US
Practice Address - Phone:586-978-8240
Practice Address - Fax:586-978-1417
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJR004112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E01416OtherBCN
MI10404OtherCAPE HEALTH
MI950E014160OtherBCBS OF MI
MI2112712Medicaid
MICH500017OtherMCARE
MA4371021OtherAETNA PPO MANAGE CARE
MI0E05115Medicare ID - Type Unspecified
MICH500017OtherMCARE