Provider Demographics
NPI:1386791788
Name:JENNIFER ZELENKA RAUCH DC LLC
Entity type:Organization
Organization Name:JENNIFER ZELENKA RAUCH DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPCSEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-842-8999
Mailing Address - Street 1:950 TAYLOR AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2282
Mailing Address - Country:US
Mailing Address - Phone:616-842-8999
Mailing Address - Fax:
Practice Address - Street 1:950 TAYLOR AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2282
Practice Address - Country:US
Practice Address - Phone:616-842-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN81080001Medicare ID - Type Unspecified
MIU66734Medicare UPIN