Healthcare Provider Details

I. General information

NPI: 1235264078
Provider Name (Legal Business Name): JOHN RIEGLEMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S MAIN ST
MAYVILLE WI
53050-1641
US

IV. Provider business mailing address

1 S MAIN ST
MAYVILLE WI
53050-1641
US

V. Phone/Fax

Practice location:
  • Phone: 920-387-5995
  • Fax: 920-387-5887
Mailing address:
  • Phone: 920-387-5995
  • Fax: 920-387-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2075-012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: