MEDICARE: MATTHEW RAUCO 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	14069	FL

General Provider Information

NPI Number	:	1417684994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW RAUCO DC

Provider Business Mailing Address
First Line	:	4423 HUNTINGTON FOREST BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-7570
Country	:	US
Telephone Number	:	904-316-3404
Fax Number	:

Provider Business Practice Location Address
First Line	:	10915 BAYMEADOWS RD STE 104
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9131
Country	:	US
Telephone Number	:	904-312-7575
Fax Number	:

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

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	08/04/2022

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