Healthcare Provider Details

I. General information

NPI: 1629144944
Provider Name (Legal Business Name): RAETHER CHIROPRACTIC OFFICE,S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 ALTONA AVE
NEW HOLSTEIN WI
53061-9542
US

IV. Provider business mailing address

2625 ALTONA AVE
NEW HOLSTEIN WI
53061-9542
US

V. Phone/Fax

Practice location:
  • Phone: 920-898-4225
  • Fax: 920-898-4597
Mailing address:
  • Phone: 920-898-4225
  • Fax: 920-898-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateWI

VIII. Authorized Official

Name: DR. JON C RAETHER
Title or Position: OWNER-CHIROPRACTOR
Credential: D.C
Phone: 920-898-4225