Provider Demographics
NPI:1710189816
Name:UNIVERSITY HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:UNIVERSITY HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAROY
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:REEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-231-3900
Mailing Address - Street 1:3555 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2140
Mailing Address - Country:US
Mailing Address - Phone:608-231-3900
Mailing Address - Fax:608-231-6800
Practice Address - Street 1:3555 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2140
Practice Address - Country:US
Practice Address - Phone:608-231-3900
Practice Address - Fax:608-231-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2228111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1932289857OtherINDIVIDUAL NPI NUMBER
WI1932289857OtherINDIVIDUAL NPI NUMBER