=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730991894
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAUSCH CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2025
-----------------------------------------------------
Last Update Date | 01/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1390 S MAPLE GROVE RD
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83709-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-672-0100
-----------------------------------------------------
Fax | 208-672-0200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1390 S MAPLE GROVE RD
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83709-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-672-0100
-----------------------------------------------------
Fax | 208-672-0200
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JEREMY RAUSCH
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 208-672-0100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------