Provider Demographics
NPI:1467486522
Name:MICHAEL, MARK A (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N CALHOUN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5902
Mailing Address - Country:US
Mailing Address - Phone:262-785-1233
Mailing Address - Fax:262-785-1258
Practice Address - Street 1:405 N CALHOUN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5902
Practice Address - Country:US
Practice Address - Phone:262-785-1233
Practice Address - Fax:262-785-1258
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1918012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI201994442014OtherBCBS
WI402681OtherWI EMPL. ID
WI38838100Medicaid
WI606473100OtherDEPT OF LABOR
WI201994442014OtherBCBS
WI402681OtherWI EMPL. ID