Provider Demographics
NPI:1962481564
Name:RESCH, ALAN W (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:W
Last Name:RESCH
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 1:1805 ALLOUEZ AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-6244
Mailing Address - Country:US
Mailing Address - Phone:920-465-0101
Mailing Address - Fax:920-468-1510
Practice Address - Street 1:1805 ALLOUEZ AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6244
Practice Address - Country:US
Practice Address - Phone:920-465-0101
Practice Address - Fax:920-468-1510
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2074-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38791600Medicaid
WIT63092Medicare UPIN
WI35107Medicare ID - Type Unspecified