Provider Demographics
NPI:1689384802
Name:BUDJAK, MICHAEL ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALEXANDER
Last Name:BUDJAK
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 1:11009 N CEDARBURG RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-4305
Mailing Address - Country:US
Mailing Address - Phone:563-549-2015
Mailing Address - Fax:
Practice Address - Street 1:4000 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-2245
Practice Address - Country:US
Practice Address - Phone:920-459-9090
Practice Address - Fax:920-459-7426
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6037-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor