Provider Demographics
NPI:1740356112
Name:TROTTIER, MICHAEL J (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:TROTTIER
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 1:10105 68TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-8379
Mailing Address - Country:US
Mailing Address - Phone:262-925-1279
Mailing Address - Fax:
Practice Address - Street 1:3120 80TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4946
Practice Address - Country:US
Practice Address - Phone:262-942-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIVO6259Medicare UPIN
WI000335769Medicare ID - Type UnspecifiedDC