Provider Demographics
NPI:1407876998
Name:DRAEGER, RICKY CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:CHARLES
Last Name:DRAEGER
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 1:1801 W KNAPP ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1380
Mailing Address - Country:US
Mailing Address - Phone:715-234-1106
Mailing Address - Fax:715-736-0960
Practice Address - Street 1:1801 W KNAPP ST
Practice Address - Street 2:SUITE 2
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1380
Practice Address - Country:US
Practice Address - Phone:715-234-1106
Practice Address - Fax:715-736-0960
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2531-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38846700Medicaid
WIU-01302Medicare UPIN
WI38846700Medicaid