Provider Demographics
NPI:1548581838
Name:RACHOW, KEITH EDWIN
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:EDWIN
Last Name:RACHOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MORRISS ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7174
Mailing Address - Country:US
Mailing Address - Phone:972-874-5900
Mailing Address - Fax:972-874-5905
Practice Address - Street 1:2200 MORRISS ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7174
Practice Address - Country:US
Practice Address - Phone:972-874-5900
Practice Address - Fax:972-874-5905
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor