=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518060516
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AARON L. RACKHAM D.C., PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 N CENTER ST
-----------------------------------------------------
City | SEBEWAING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48759-1406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-883-9090
-----------------------------------------------------
Fax | 989-883-2375
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 705
-----------------------------------------------------
City | SEBEWAING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48759-0705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-883-9090
-----------------------------------------------------
Fax | 989-883-2375
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. AARON LEE RECKHAM
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 989-883-9090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | L767930
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------