Provider Demographics
NPI:1952418154
Name:DEFERE, MICHELLE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:DEFERE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 STATE ROAD 175
Mailing Address - Street 2:
Mailing Address - City:HUBERTUS
Mailing Address - State:WI
Mailing Address - Zip Code:53033-9677
Mailing Address - Country:US
Mailing Address - Phone:262-628-1960
Mailing Address - Fax:262-628-1947
Practice Address - Street 1:1282 STATE ROAD 175
Practice Address - Street 2:
Practice Address - City:HUBERTUS
Practice Address - State:WI
Practice Address - Zip Code:53033-9677
Practice Address - Country:US
Practice Address - Phone:262-628-1960
Practice Address - Fax:262-628-1947
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor