Provider Demographics
NPI:1134390909
Name:MICHAEL V. CIRILLI D.C. INC.
Entity type:Organization
Organization Name:MICHAEL V. CIRILLI D.C. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:CIRILLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-356-4478
Mailing Address - Street 1:8683 STUART AVE
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-9014
Mailing Address - Country:US
Mailing Address - Phone:715-356-4478
Mailing Address - Fax:715-356-7775
Practice Address - Street 1:8683 STUART AVE
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9014
Practice Address - Country:US
Practice Address - Phone:715-356-4478
Practice Address - Fax:715-356-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000075464Medicare PIN