Provider Demographics
NPI:1801931373
Name:GLESSING, RICHARD DALE (DC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DALE
Last Name:GLESSING
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 1:1219 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1202
Mailing Address - Country:US
Mailing Address - Phone:715-682-4033
Mailing Address - Fax:715-682-4033
Practice Address - Street 1:1219 MAIN ST W
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1202
Practice Address - Country:US
Practice Address - Phone:715-682-4033
Practice Address - Fax:715-682-4033
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1567-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38766200Medicaid
WI391517596014OtherANTHEM
WIT62011Medicare UPIN