Provider Demographics
NPI:1902865504
Name:RACKHAM, AARON LEE (DC)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:LEE
Last Name:RACKHAM
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 1:9396 SW GREENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-9445
Mailing Address - Country:US
Mailing Address - Phone:616-754-7717
Mailing Address - Fax:616-754-7791
Practice Address - Street 1:9396 SW GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-9445
Practice Address - Country:US
Practice Address - Phone:616-754-7717
Practice Address - Fax:616-754-7791
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2910050Medicaid
MI950E910580OtherBCBS
MI0P15320Medicare ID - Type Unspecified
MIP15320001Medicare UPIN