Provider Demographics
NPI:1891403556
Name:RARICK, JON SR
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:
Last Name:RARICK
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 PARAGON RD STE 2022
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45475-5001
Mailing Address - Country:US
Mailing Address - Phone:937-572-3789
Mailing Address - Fax:
Practice Address - Street 1:6941 EASTPOINT CT
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3227
Practice Address - Country:US
Practice Address - Phone:937-572-3789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider