Provider Demographics
NPI:1275822843
Name:RACKHAM CHIROPRACTIC PLUS PLLC
Entity Type:Organization
Organization Name:RACKHAM CHIROPRACTIC PLUS PLLC
Other - Org Name:DR. RACKHAM'S CHIROPRACTIC PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:RACKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-754-7717
Mailing Address - Street 1:9396 SW GREENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-9445
Mailing Address - Country:US
Mailing Address - Phone:616-754-7717
Mailing Address - Fax:616-754-7791
Practice Address - Street 1:9396 SW GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-9445
Practice Address - Country:US
Practice Address - Phone:616-754-7717
Practice Address - Fax:616-754-7791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00219768OtherPALMETTO
MI1010600OtherMCLAREN
MI0989924OtherHEALTH PLUS
MI2910050Medicaid