Provider Demographics
NPI:1518050764
Name:REAK, DENNIS L (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:REAK
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 1:750 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-5216
Mailing Address - Country:US
Mailing Address - Phone:715-423-3020
Mailing Address - Fax:715-423-3012
Practice Address - Street 1:750 DEWEY ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-5216
Practice Address - Country:US
Practice Address - Phone:715-423-3020
Practice Address - Fax:715-423-3012
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4244-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor