Provider Demographics
NPI:1477510949
Name:STAFFORD, MICHELLE S (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:S
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:DRAGGOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 510444
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151
Mailing Address - Country:US
Mailing Address - Phone:262-785-1811
Mailing Address - Fax:262-785-9887
Practice Address - Street 1:3333 S SUNNYSLOPE RD
Practice Address - Street 2:108
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4502
Practice Address - Country:US
Practice Address - Phone:262-785-1811
Practice Address - Fax:262-785-9887
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38921800Medicaid
WI000035803Medicare PIN