Provider Demographics
NPI:1275417958
Name:AVILA, MICHAELA BONITA (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:BONITA
Last Name:AVILA
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 1:3120 EDMONTON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-4593
Mailing Address - Country:US
Mailing Address - Phone:608-318-5300
Mailing Address - Fax:608-318-5353
Practice Address - Street 1:3120 EDMONTON DR STE 100
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-4593
Practice Address - Country:US
Practice Address - Phone:608-318-5300
Practice Address - Fax:608-318-5353
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6321-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor