Provider Demographics
NPI:1285852301
Name:RAUCH CHIROPRACTIC LIFE CENTER
Entity Type:Organization
Organization Name:RAUCH CHIROPRACTIC LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:RAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-978-8240
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI004112111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICH500017OtherMCARE
MI0E01416OtherBCBS
MI4740719Medicaid
MI2112712Medicaid
MI0E01400OtherBCBS GROUP
MI0E05381OtherBCBS
MI667983OtherACN
MI151224OtherGREATLAKES
MI11279056OtherCAQH
MI4740719Medicaid
MI0E01416OtherBCBS
MI0E05381OtherBCBS
MI2112712Medicaid