Provider Demographics
NPI:1467697912
Name:REINEKING, BENJAMIN R (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:R
Last Name:REINEKING
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 1:1314 W COLLEGE AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-4976
Mailing Address - Country:US
Mailing Address - Phone:920-733-9999
Mailing Address - Fax:920-733-9998
Practice Address - Street 1:1314 W COLLEGE AVE STE 6
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-4976
Practice Address - Country:US
Practice Address - Phone:920-733-9999
Practice Address - Fax:920-733-9998
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4456-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor