Individual
DR. MARK A MICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
405 N CALHOUN RD, SUITE 105, BROOKFIELD, WI 53005-5902
(262) 785-1233
(262) 785-1258
Mailing address
405 N CALHOUN RD, SUITE 105, BROOKFIELD, WI 53005-5902
(262) 785-1233
(262) 785-1258
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1918012
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201994442014
BCBS
WI
05
—
38838100
—
WI
01
—
402681
WI EMPL. ID
WI
01
—
606473100
DEPT OF LABOR
WI
Enumeration date
07/11/2006
Last updated
10/15/2010
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