Provider Demographics
NPI:1447307939
Name:RAUCH, JEFFREY S (DC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:S
Last Name:RAUCH
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 1:57 IRA RD
Mailing Address - Street 2:SUITE 156
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3504
Mailing Address - Country:US
Mailing Address - Phone:516-729-2629
Mailing Address - Fax:718-733-0351
Practice Address - Street 1:4708 104TH ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2811
Practice Address - Country:US
Practice Address - Phone:718-725-7417
Practice Address - Fax:718-476-7234
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor