Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2014002027 | MO |
NPI | 1003239989 |
---|---|
Provider Name | Andrew Rackovan |
First Address | Saint Charles, MO 63301-4872 |
Second Address | Saint Charles, MO 63301-4872 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2014 |
Last Update Date | 05/03/2014 |