Healthcare Provider Details

I. General information

NPI: 1215890926
Provider Name (Legal Business Name): RAEANNE MARIE KOLBECK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N WASHINGTON ST
THORP WI
54771-9239
US

IV. Provider business mailing address

430 S 4TH AVE
OWEN WI
54460-9751
US

V. Phone/Fax

Practice location:
  • Phone: 715-669-3361
  • Fax:
Mailing address:
  • Phone: 715-313-0991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6362-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: