Provider Demographics
NPI:1699838623
Name:BRANNICK, MICHELLE ANNE (DC, ND)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANNE
Last Name:BRANNICK
Suffix:
Gender:F
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ST. CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2373
Mailing Address - Country:US
Mailing Address - Phone:630-444-0066
Mailing Address - Fax:630-444-1656
Practice Address - Street 1:1013 E 31ST ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE PARK
Practice Address - State:IL
Practice Address - Zip Code:60526-1218
Practice Address - Country:US
Practice Address - Phone:708-447-2468
Practice Address - Fax:630-444-1656
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010197111NN1001X, 111NS0005X, 111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NS0005XChiropractic ProvidersChiropractorSports Physician