Provider Demographics
NPI:1174686745
Name:RAJACICH, JOAN GAIL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:GAIL
Last Name:RAJACICH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:SEDAN
Mailing Address - State:KS
Mailing Address - Zip Code:67361-1416
Mailing Address - Country:US
Mailing Address - Phone:620-725-3160
Mailing Address - Fax:
Practice Address - Street 1:311 E ELM ST
Practice Address - Street 2:
Practice Address - City:SEDAN
Practice Address - State:KS
Practice Address - Zip Code:67361-1416
Practice Address - Country:US
Practice Address - Phone:620-725-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU42272Medicare UPIN
KS023808Medicare ID - Type UnspecifiedCHIROPRACTOR