Provider Demographics
NPI:1740934355
Name:RASCH, JORDAN DANIEL
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:DANIEL
Last Name:RASCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14155 DALLAS PKWY APT 1353
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-4450
Mailing Address - Country:US
Mailing Address - Phone:618-530-3694
Mailing Address - Fax:
Practice Address - Street 1:4302 W LOVERS LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-2804
Practice Address - Country:US
Practice Address - Phone:214-862-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15033111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician