Provider Demographics
NPI:1215140595
Name:KEN RAKOWICZ DC PC
Entity type:Organization
Organization Name:KEN RAKOWICZ DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-540-6780
Mailing Address - Street 1:1600 TOWN COMMONS DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48855
Mailing Address - Country:US
Mailing Address - Phone:517-540-6780
Mailing Address - Fax:517-540-6782
Practice Address - Street 1:1600 TOWN COMMONS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48855-6807
Practice Address - Country:US
Practice Address - Phone:517-540-6780
Practice Address - Fax:517-540-6782
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEN RAKOWICZ DC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-07
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
MI2301007620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950D710470OtherBCBS
MI0N81530Medicare ID - Type Unspecified
MIY01110Medicare UPIN
MIU92342Medicare UPIN