Provider Demographics
NPI:1750485843
Name:PAPKE, MICHAEL J (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:PAPKE
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 1:1939 N ROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-4369
Mailing Address - Country:US
Mailing Address - Phone:815-968-1133
Mailing Address - Fax:815-968-1134
Practice Address - Street 1:1939 N ROCKTON AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-4369
Practice Address - Country:US
Practice Address - Phone:815-968-1133
Practice Address - Fax:815-968-1134
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
10182041OtherBCBS
10182041OtherBCBS