Provider Demographics
NPI:1538126974
Name:BARANCZYK, RICCI (DC)
Entity Type:Individual
Prefix:MR
First Name:RICCI
Middle Name:
Last Name:BARANCZYK
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 1:2201 ONEIDA ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304
Mailing Address - Country:US
Mailing Address - Phone:920-496-1556
Mailing Address - Fax:920-496-9860
Practice Address - Street 1:2201 S ONEIDA ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304
Practice Address - Country:US
Practice Address - Phone:920-496-1556
Practice Address - Fax:920-496-9860
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2754012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38864600Medicaid
WI38864600Medicaid
70807Medicare ID - Type Unspecified