MEDICARE: DR. FRED W RASCHKE DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1788012	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	350045133	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1750382537	OTHER		NPI # TYPE 2
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	343707	OTHER	WI	EIN #

General Provider Information

NPI Number	:	1922151687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED W RASCHKE DC

Provider Business Mailing Address
First Line	:	304 S WESTERN AVE
Second Line	:
City	:	WAUPACA
State	:	WI
Zip	:	54981-5703
Country	:	US
Telephone Number	:	715-258-8211
Fax Number	:	715-258-0118

Provider Business Practice Location Address
First Line	:	304 S WESTERN AVE
Second Line	:
City	:	WAUPACA
State	:	WI
Zip	:	54981-5703
Country	:	US
Telephone Number	:	715-258-8211
Fax Number	:	715-258-0118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/10/2024

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Directions to “ DR. FRED W RASCHKE DC” Practice Location

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