Provider Demographics
NPI:1124028071
Name:VRIEZE, PETER W (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:W
Last Name:VRIEZE
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:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-0303
Mailing Address - Country:US
Mailing Address - Phone:715-246-7000
Mailing Address - Fax:715-246-7002
Practice Address - Street 1:706 W 4TH ST
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1440
Practice Address - Country:US
Practice Address - Phone:715-246-7000
Practice Address - Fax:715-246-7002
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38760600Medicaid
MN91924VROtherBLUE CROSS BLUE SHEILD
WI75023Medicare ID - Type Unspecified