Provider Demographics
NPI:1679648679
Name:RAUSCH, JEREMY HENRY (DC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:HENRY
Last Name:RAUSCH
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 1:1390 S MAPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1610
Mailing Address - Country:US
Mailing Address - Phone:208-672-0100
Mailing Address - Fax:208-672-0200
Practice Address - Street 1:1390 S MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1610
Practice Address - Country:US
Practice Address - Phone:208-672-0100
Practice Address - Fax:208-672-0200
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA- 1169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807410300Medicaid
ID807410300Medicaid