Provider Demographics
NPI:1629139779
Name:BARTELL, MICHAEL WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:BARTELL
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 1:12 6TH AVE, SUITE 103
Mailing Address - Street 2:PO BOX 113
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334
Mailing Address - Country:US
Mailing Address - Phone:320-634-3000
Mailing Address - Fax:
Practice Address - Street 1:16151 STATE HIGHWAY 29
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-2142
Practice Address - Country:US
Practice Address - Phone:320-634-3000
Practice Address - Fax:320-634-1948
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN013916500Medicaid
MN013916500Medicaid