Provider Demographics
NPI:1235264078
Name:RIEGLEMAN, JOHN (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:RIEGLEMAN
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 1:1 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53050-1641
Mailing Address - Country:US
Mailing Address - Phone:920-387-5995
Mailing Address - Fax:920-387-5887
Practice Address - Street 1:1 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:WI
Practice Address - Zip Code:53050-1641
Practice Address - Country:US
Practice Address - Phone:920-387-5995
Practice Address - Fax:920-387-5887
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2075-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT63101Medicare UPIN
WI000035753Medicare ID - Type Unspecified