Provider Demographics
NPI:1649484221
Name:CHEN, MICHAEL H (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:CHEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4848 S 76TH ST
Mailing Address - Street 2:SUITE. 205
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4361
Mailing Address - Country:US
Mailing Address - Phone:414-282-9500
Mailing Address - Fax:414-282-9513
Practice Address - Street 1:4848 S 76TH ST
Practice Address - Street 2:SUITE. 205
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4361
Practice Address - Country:US
Practice Address - Phone:414-282-9500
Practice Address - Fax:414-282-9513
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2359-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU22845Medicare UPIN