Provider Demographics
NPI:1639587074
Name:MADELINE RANNOW
Entity Type:Organization
Organization Name:MADELINE RANNOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMP
Authorized Official - Prefix:MS
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:I
Authorized Official - Last Name:RANNOW
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:509-551-8624
Mailing Address - Street 1:3320 S GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-8203
Mailing Address - Country:US
Mailing Address - Phone:509-551-8624
Mailing Address - Fax:
Practice Address - Street 1:660 JADWIN AVE STE A
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4241
Practice Address - Country:US
Practice Address - Phone:509-943-5314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60486969OtherWASHINGTON STATE DEPARTMENT OF HEALTH