Provider Demographics
NPI:1861553612
Name:RACEK, DONALD J (DC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:RACEK
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 1:60 EVERGREEN PL
Mailing Address - Street 2:SUITE 902
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2106
Mailing Address - Country:US
Mailing Address - Phone:973-675-1000
Mailing Address - Fax:973-675-9909
Practice Address - Street 1:60 EVERGREEN PL
Practice Address - Street 2:SUITE 902
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2106
Practice Address - Country:US
Practice Address - Phone:973-675-1000
Practice Address - Fax:973-675-9909
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00552500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8698708Medicaid
NJ042121Medicare ID - Type Unspecified