Provider Demographics
NPI:1568503167
Name:REIDINGER, PAUL J (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:REIDINGER
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 1:1177 S WASHBURN ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-8053
Mailing Address - Country:US
Mailing Address - Phone:920-235-5522
Mailing Address - Fax:920-235-6417
Practice Address - Street 1:1177 S WASHBURN ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-8053
Practice Address - Country:US
Practice Address - Phone:920-235-5522
Practice Address - Fax:920-235-6417
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38837700Medicaid
WI75906Medicare ID - Type Unspecified