Provider Demographics
NPI:1508859174
Name:ZITZKE, MICHELLE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANN
Last Name:ZITZKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 S KINNICKINNIC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1625
Mailing Address - Country:US
Mailing Address - Phone:414-744-5010
Mailing Address - Fax:414-744-5141
Practice Address - Street 1:2331 S KINNICKINNIC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-1625
Practice Address - Country:US
Practice Address - Phone:414-744-5010
Practice Address - Fax:414-744-5141
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4119-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38967200Medicaid
WIV05970Medicare UPIN
WI38967200Medicaid