Provider Demographics
NPI:1114954971
Name:DRAEGER, DAVID DEWAINE (DC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DEWAINE
Last Name:DRAEGER
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 1:5105 HWY 70 W
Mailing Address - Street 2:PO BOX 2708
Mailing Address - City:EAGLE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54521
Mailing Address - Country:US
Mailing Address - Phone:715-479-5995
Mailing Address - Fax:715-479-1617
Practice Address - Street 1:5105 HWY 70 W.
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:WI
Practice Address - Zip Code:54521
Practice Address - Country:US
Practice Address - Phone:715-479-5995
Practice Address - Fax:715-479-1617
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3163012111N00000X
MI3163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38884400Medicaid
110139656OtherRAILROAD MEDICARE
U53160Medicare UPIN
MI703000002Medicare UPIN