Provider Demographics
NPI:1184601395
Name:RAWA, JOHN DONALD JR (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DONALD
Last Name:RAWA
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4880 BIRCHDALE DR
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:PA
Mailing Address - Zip Code:16417-1822
Mailing Address - Country:US
Mailing Address - Phone:814-774-1400
Mailing Address - Fax:814-774-3708
Practice Address - Street 1:4880 BIRCHDALE DR
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:PA
Practice Address - Zip Code:16417-1822
Practice Address - Country:US
Practice Address - Phone:814-774-1400
Practice Address - Fax:814-774-3708
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006470L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG1807058OtherBLUE CROSS
PA0017811730001Medicaid
PAU64295Medicare UPIN
PA878047Medicare ID - Type Unspecified