Provider Demographics
NPI:1336211945
Name:RADEMAKER, TREVA ERIN (DC)
Entity Type:Individual
Prefix:DR
First Name:TREVA
Middle Name:ERIN
Last Name:RADEMAKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:TREVA
Other - Middle Name:ERIN
Other - Last Name:DODDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:25331 W LOOMIS RD
Mailing Address - Street 2:
Mailing Address - City:WIND LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53185-1425
Mailing Address - Country:US
Mailing Address - Phone:262-347-9066
Mailing Address - Fax:
Practice Address - Street 1:6278 S 108TH ST
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2527
Practice Address - Country:US
Practice Address - Phone:414-235-8740
Practice Address - Fax:414-435-3129
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3746-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38938300Medicaid
WIU84668Medicare UPIN
WIK400124231Medicare PIN
WI000201234Medicare ID - Type Unspecified