Provider Demographics
NPI:1689087876
Name:RAE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:RAE CHIROPRACTIC, LLC
Other - Org Name:PRESCOTT CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARINA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:PATNODE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-307-7768
Mailing Address - Street 1:W11199 575TH AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54021-7636
Mailing Address - Country:US
Mailing Address - Phone:715-307-7768
Mailing Address - Fax:
Practice Address - Street 1:1380 N ACRES RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:WI
Practice Address - Zip Code:54021-7061
Practice Address - Country:US
Practice Address - Phone:715-262-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4444-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI350004161Medicare UPIN