1396057444 NPI number — K. M. RACHOW ENTERPRISES LLC

Table of content: (NPI 1396057444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396057444 NPI number — K. M. RACHOW ENTERPRISES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
K. M. RACHOW ENTERPRISES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SPINE TIME FAMILY CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396057444
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 MORRISS RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
FLOWER MOUND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75028-3598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-874-5900
Provider Business Mailing Address Fax Number:
972-874-5905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 MORRISS RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FLOWER MOUND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75028-3598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-874-5900
Provider Business Practice Location Address Fax Number:
972-874-5905
Provider Enumeration Date:
07/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RACHOW
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
EDWIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-539-3105

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  11501 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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