Provider Demographics
NPI:1922151687
Name:RASCHKE, FRED W (DC)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:W
Last Name:RASCHKE
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:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:WEYAUWEGA
Mailing Address - State:WI
Mailing Address - Zip Code:54983-0736
Mailing Address - Country:US
Mailing Address - Phone:920-867-2451
Mailing Address - Fax:920-867-2415
Practice Address - Street 1:N1992 COUNTY ROAD F
Practice Address - Street 2:
Practice Address - City:WEYAUWEGA
Practice Address - State:WI
Practice Address - Zip Code:54983-0736
Practice Address - Country:US
Practice Address - Phone:920-867-2451
Practice Address - Fax:920-867-2415
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1788012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI343707OtherEIN #
350045133OtherRAILROAD MEDICARE
WI38777200Medicaid
1750382537OtherNPI # TYPE 2
1750382537OtherNPI # TYPE 2
WI343707OtherEIN #