Provider Demographics
NPI:1407932130
Name:RAUCH, MICHAEL WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
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 1:10 JANET RD APT 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1621
Mailing Address - Country:US
Mailing Address - Phone:774-277-7400
Mailing Address - Fax:
Practice Address - Street 1:329 CENTRE ST UNIT C
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-1211
Practice Address - Country:US
Practice Address - Phone:617-524-4878
Practice Address - Fax:617-524-0075
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35765Medicare ID - Type Unspecified