Provider Demographics
NPI:1518966555
Name:KNAUF, REX JAMES (MS, DC,CCEP)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:JAMES
Last Name:KNAUF
Suffix:
Gender:M
Credentials:MS, DC,CCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:CHILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53014-1346
Mailing Address - Country:US
Mailing Address - Phone:920-849-9150
Mailing Address - Fax:920-849-7344
Practice Address - Street 1:26 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:CHILTON
Practice Address - State:WI
Practice Address - Zip Code:53014-1346
Practice Address - Country:US
Practice Address - Phone:920-849-9150
Practice Address - Fax:920-849-7344
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2010-08-12
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
WI2549-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38860700Medicaid
WI70191Medicare ID - Type Unspecified
WIU01812Medicare UPIN