Provider Demographics
NPI:1891710539
Name:FLETCHER, MICHAEL WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:FLETCHER
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 1:440 N KOELLER ST
Mailing Address - Street 2:440 N. KOELLER ST.
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-4111
Mailing Address - Country:US
Mailing Address - Phone:920-230-2800
Mailing Address - Fax:920-651-4289
Practice Address - Street 1:440 N. KOELLER ST.
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54903-2525
Practice Address - Country:US
Practice Address - Phone:920-233-2828
Practice Address - Fax:920-232-2829
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1934-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38796500Medicaid
61918Medicare UPIN
WI38796500Medicaid