Provider Demographics
NPI:1831239367
Name:REX, WADE J (LAC)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:J
Last Name:REX
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 E RACINE AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-6462
Mailing Address - Country:US
Mailing Address - Phone:262-832-8888
Mailing Address - Fax:262-806-0028
Practice Address - Street 1:1428 E RACINE AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-6462
Practice Address - Country:US
Practice Address - Phone:262-832-8888
Practice Address - Fax:262-806-0028
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2493171100000X
WI491-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty