Provider Demographics
NPI:1275686834
Name:CIRILLI, MICHAEL VINCENT (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VINCENT
Last Name:CIRILLI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:VINCENT
Other - Last Name:CIRILLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:8683 STUART AVE
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-9014
Mailing Address - Country:US
Mailing Address - Phone:715-956-4478
Mailing Address - Fax:715-356-7775
Practice Address - Street 1:8683 STUART AVE
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9014
Practice Address - Country:US
Practice Address - Phone:715-956-4478
Practice Address - Fax:715-356-7775
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2302111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38834900Medicaid