Provider Demographics
NPI:1437222072
Name:BEHNCKE, RICKY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:LEE
Last Name:BEHNCKE
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 1:409 E MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-3186
Mailing Address - Country:US
Mailing Address - Phone:608-754-3192
Mailing Address - Fax:608-754-3256
Practice Address - Street 1:409 E MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-3186
Practice Address - Country:US
Practice Address - Phone:608-754-3192
Practice Address - Fax:608-754-3256
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38761700Medicaid
WI12031OtherDEAN HEALTH PLAN
WI12031OtherDEAN HEALTH PLAN