Provider Demographics
NPI:1851391189
Name:RAEON, FLOYD J (DC)
Entity Type:Individual
Prefix:DR
First Name:FLOYD
Middle Name:J
Last Name:RAEON
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 1:1832 E AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4884
Mailing Address - Country:US
Mailing Address - Phone:248-852-6886
Mailing Address - Fax:248-852-7789
Practice Address - Street 1:1832 E AUBURN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4884
Practice Address - Country:US
Practice Address - Phone:248-852-6886
Practice Address - Fax:248-852-7789
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301300316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F35209OtherBCBSM
MI4722452Medicaid
MI0F35209Medicare ID - Type Unspecified
MI4722452Medicaid