Provider Demographics
NPI:1710034145
Name:DAUK, JEFFRY RAYMOND (DC)
Entity Type:Individual
Prefix:
First Name:JEFFRY
Middle Name:RAYMOND
Last Name:DAUK
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 1:2231 S 92ND ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1521
Mailing Address - Country:US
Mailing Address - Phone:414-545-8555
Mailing Address - Fax:414-545-6606
Practice Address - Street 1:2231 S 92ND ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1521
Practice Address - Country:US
Practice Address - Phone:414-545-8555
Practice Address - Fax:414-545-6606
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT61733Medicare UPIN
WI35793Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER