Provider Demographics
NPI:1629148796
Name:RAUHAUSER, JEREMY DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DALE
Last Name:RAUHAUSER
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 1:2430 JUSTIN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3091
Mailing Address - Country:US
Mailing Address - Phone:972-333-3206
Mailing Address - Fax:
Practice Address - Street 1:2430 JUSTIN RD STE B
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-3090
Practice Address - Country:US
Practice Address - Phone:972-317-3146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83600XOtherBLUE CROSS BLUE SHIELD
TX6591OtherLISCENCE #
TX85101FMedicare ID - Type Unspecified
TX83600XOtherBLUE CROSS BLUE SHIELD