Provider Demographics
NPI:1275767451
Name:MAIGATTER, RENEE MARIE (DC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:MARIE
Last Name:MAIGATTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 MEMORIAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-6700
Mailing Address - Country:US
Mailing Address - Phone:920-652-9887
Mailing Address - Fax:
Practice Address - Street 1:1314 MEMORIAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-6700
Practice Address - Country:US
Practice Address - Phone:920-652-9887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1275767451Medicaid