Provider Demographics
NPI:1518063684
Name:RITZENTHALER, KEVIN E (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:E
Last Name:RITZENTHALER
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 1:2114 SCHOFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2365
Mailing Address - Country:US
Mailing Address - Phone:715-355-4224
Mailing Address - Fax:
Practice Address - Street 1:2114 SCHOFIELD AVE
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-2365
Practice Address - Country:US
Practice Address - Phone:715-355-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3727-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38929800Medicaid
WI350051983OtherRAILROAD MEDICARE
68360OtherSECURITY HEALTH PLAN
U83427Medicare UPIN
WI000135745Medicare ID - Type Unspecified