Provider Demographics
NPI:1578587564
Name:KLOPPENBURG, MICHAEL DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:KLOPPENBURG
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 1:121 S SUGAR ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47220-2026
Mailing Address - Country:US
Mailing Address - Phone:812-358-4084
Mailing Address - Fax:812-358-3270
Practice Address - Street 1:121 S SUGAR ST
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47220-2026
Practice Address - Country:US
Practice Address - Phone:812-358-4084
Practice Address - Fax:812-358-3270
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000493A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN386250Medicare ID - Type Unspecified
IN029795Medicare UPIN