Provider Demographics
NPI:1932103892
Name:RAKER, JAMES D (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:RAKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:RAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1414 ARKANSAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1604
Mailing Address - Country:US
Mailing Address - Phone:870-773-7246
Mailing Address - Fax:870-772-2568
Practice Address - Street 1:1414 ARKANSAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1604
Practice Address - Country:US
Practice Address - Phone:870-773-7246
Practice Address - Fax:870-772-2568
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1141111N00000X
TX5184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74281902Medicaid
TX74281902Medicaid
AR59695B438Medicare PIN