Provider Demographics
NPI:1528095205
Name:RAKOWICZ, KENNETH W (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:W
Last Name:RAKOWICZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:48855-6807
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
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N81530Medicare ID - Type Unspecified
MIY01110Medicare UPIN