Provider Demographics
NPI:1245230291
Name:ZELENKA-RAUCH, JENNIFER (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:ZELENKA-RAUCH
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 1:950 TAYLOR AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2282
Mailing Address - Country:US
Mailing Address - Phone:616-842-8999
Mailing Address - Fax:
Practice Address - Street 1:950 TAYLOR AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2282
Practice Address - Country:US
Practice Address - Phone:616-842-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900016838OtherPRIORITY HEALTH
MI144678917Medicaid
MI950G010810OtherBCBS
MION81080Medicare ID - Type Unspecified
MI950G010810OtherBCBS