Provider Demographics
NPI:1538222427
Name:RAUCH, THADDEUS JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:JAMES
Last Name:RAUCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-1635
Mailing Address - Country:US
Mailing Address - Phone:513-895-9000
Mailing Address - Fax:513-895-9001
Practice Address - Street 1:1355 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1635
Practice Address - Country:US
Practice Address - Phone:513-895-9000
Practice Address - Fax:513-895-9001
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2305651Medicaid
OHU89540Medicare UPIN
OH2305651Medicaid