Healthcare Provider Details

I. General information

NPI: 1578099537
Provider Name (Legal Business Name): MADELYN RAUCH D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 SCHOOL CIR
EAST HARDWICK VT
05836-9616
US

IV. Provider business mailing address

676 STOWE HOLLOW RD
STOWE VT
05672-4875
US

V. Phone/Fax

Practice location:
  • Phone: 802-472-3033
  • Fax:
Mailing address:
  • Phone: 732-977-6748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006.0130115
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: