Provider Demographics
NPI:1225216708
Name:RANICKE, RICHARD JOSEPH JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:RANICKE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6051 W BROWN DEER RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2263
Mailing Address - Country:US
Mailing Address - Phone:414-355-5301
Mailing Address - Fax:414-355-5483
Practice Address - Street 1:6051 W BROWN DEER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-2263
Practice Address - Country:US
Practice Address - Phone:414-355-5301
Practice Address - Fax:414-355-5483
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU10963Medicare UPIN