Provider Demographics
NPI:1992832794
Name:WICHGERS, R. MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:R. MICHAEL
Middle Name:
Last Name:WICHGERS
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 1:5620 S 92ND ST
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2216
Mailing Address - Country:US
Mailing Address - Phone:414-425-0761
Mailing Address - Fax:
Practice Address - Street 1:9114 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-2809
Practice Address - Country:US
Practice Address - Phone:414-258-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1456-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor