Provider Demographics
NPI:1750336186
Name:DRAEGER, REVA R (DC)
Entity type:Individual
Prefix:DR
First Name:REVA
Middle Name:R
Last Name:DRAEGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 SCHOFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2365
Mailing Address - Country:US
Mailing Address - Phone:715-355-4224
Mailing Address - Fax:715-355-4120
Practice Address - Street 1:2114 SCHOFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-2365
Practice Address - Country:US
Practice Address - Phone:715-355-4224
Practice Address - Fax:715-355-4120
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38883900Medicaid
WIT61799Medicare UPIN