Provider Demographics
NPI:1629144944
Name:RAETHER CHIROPRACTIC OFFICE,S.C.
Entity Type:Organization
Organization Name:RAETHER CHIROPRACTIC OFFICE,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAETHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-898-4225
Mailing Address - Street 1:2625 ALTONA AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HOLSTEIN
Mailing Address - State:WI
Mailing Address - Zip Code:53061-9542
Mailing Address - Country:US
Mailing Address - Phone:920-898-4225
Mailing Address - Fax:920-898-4597
Practice Address - Street 1:2625 ALTONA AVE
Practice Address - Street 2:
Practice Address - City:NEW HOLSTEIN
Practice Address - State:WI
Practice Address - Zip Code:53061-9542
Practice Address - Country:US
Practice Address - Phone:920-898-4225
Practice Address - Fax:920-898-4597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty