Provider Demographics
NPI:1346637618
Name:ENNSMANN, MICHELLE EVELYN (DC, ND)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:EVELYN
Last Name:ENNSMANN
Suffix:
Gender:F
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0S165 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1245
Mailing Address - Country:US
Mailing Address - Phone:630-216-5916
Mailing Address - Fax:
Practice Address - Street 1:0S165 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1245
Practice Address - Country:US
Practice Address - Phone:630-216-5916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL9030014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor