Provider Demographics
NPI:1649335050
Name:RAUCCI, MICHAEL C (DC, DIBCN)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:RAUCCI
Suffix:
Gender:M
Credentials:DC, DIBCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 SIMON DR
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-2112
Mailing Address - Country:US
Mailing Address - Phone:845-744-8050
Mailing Address - Fax:845-744-5129
Practice Address - Street 1:42 SIMON DR
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-2112
Practice Address - Country:US
Practice Address - Phone:845-744-8050
Practice Address - Fax:845-744-5129
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007742111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX02981Medicare ID - Type Unspecified