Healthcare Provider Details

I. General information

NPI: 1245193234
Provider Name (Legal Business Name): BLAKE RAUSCH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1123 KEAUNUI DR STE 228
EWA BEACH HI
96706-6370
US

IV. Provider business mailing address

91-1123 KEAUNUI DR STE 228
EWA BEACH HI
96706-6370
US

V. Phone/Fax

Practice location:
  • Phone: 808-321-0253
  • Fax:
Mailing address:
  • Phone: 808-321-0253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-1620
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: