Provider Demographics
NPI:1558945840
Name:MADRAGA, RACHEL DIANNE
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:DIANNE
Last Name:MADRAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 W COOK RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-3214
Mailing Address - Country:US
Mailing Address - Phone:260-483-5588
Mailing Address - Fax:260-489-1819
Practice Address - Street 1:1114 W COOK RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-3214
Practice Address - Country:US
Practice Address - Phone:260-483-5588
Practice Address - Fax:260-489-1819
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003230A111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor