Provider Demographics
NPI:1447344551
Name:BERKLEY, MICHAEL TODD (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TODD
Last Name:BERKLEY
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 1:322 CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:LACROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:64601
Mailing Address - Country:US
Mailing Address - Phone:608-784-4639
Mailing Address - Fax:608-784-3279
Practice Address - Street 1:322 CAMERON AVE
Practice Address - Street 2:
Practice Address - City:LACROSSE
Practice Address - State:WI
Practice Address - Zip Code:64601
Practice Address - Country:US
Practice Address - Phone:608-784-4639
Practice Address - Fax:608-784-3279
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38853800Medicaid
0010Medicare ID - Type Unspecified
WI38853800Medicaid