Provider Demographics
NPI:1407005473
Name:REINKE, SUSAN M (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:REINKE
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 1:733 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1473
Mailing Address - Country:US
Mailing Address - Phone:262-763-7373
Mailing Address - Fax:262-763-8184
Practice Address - Street 1:733 N PINE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1473
Practice Address - Country:US
Practice Address - Phone:262-763-7373
Practice Address - Fax:262-763-8184
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4446-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor