Provider Demographics
NPI:1447330303
Name:RAK, EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:RAK
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 1:1303 BEN SAWYER BLVD
Mailing Address - Street 2:STE. 7
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4589
Mailing Address - Country:US
Mailing Address - Phone:843-971-8020
Mailing Address - Fax:843-971-8285
Practice Address - Street 1:1303 BEN SAWYER BLVD
Practice Address - Street 2:STE. 7
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4589
Practice Address - Country:US
Practice Address - Phone:843-971-8020
Practice Address - Fax:843-971-8285
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC571106284Medicare UPIN
SCU798760281Medicare ID - Type Unspecified