Provider Demographics
NPI:1821223405
Name:RAO, MADAN CHAMKUR (DC)
Entity Type:Individual
Prefix:DR
First Name:MADAN
Middle Name:CHAMKUR
Last Name:RAO
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 1:12921 SHOPS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6631
Mailing Address - Country:US
Mailing Address - Phone:512-263-3334
Mailing Address - Fax:
Practice Address - Street 1:12921 SHOPS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-6631
Practice Address - Country:US
Practice Address - Phone:512-263-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB105652Medicare PIN