Provider Demographics
NPI:1376593400
Name:HARTRICH, MICHELLE LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LOUISE
Last Name:HARTRICH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:LOUISE
Other - Last Name:EASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4925 STONE FALLS CTR
Mailing Address - Street 2:SUITE B
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7800
Mailing Address - Country:US
Mailing Address - Phone:618-632-9355
Mailing Address - Fax:
Practice Address - Street 1:4925 STONE FALLS CTR
Practice Address - Street 2:SUITE B
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-7800
Practice Address - Country:US
Practice Address - Phone:618-632-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor