Provider Demographics
NPI:1871606566
Name:MICHALSKI, JAMIE ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ROBERT
Last Name:MICHALSKI
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:N64W24050 MAIN ST
Mailing Address - Street 2:SUITE 306B
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3071
Mailing Address - Country:US
Mailing Address - Phone:262-246-9181
Mailing Address - Fax:262-246-9182
Practice Address - Street 1:N64W24050 MAIN ST
Practice Address - Street 2:SUITE 306B
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3071
Practice Address - Country:US
Practice Address - Phone:262-246-9181
Practice Address - Fax:262-246-9182
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3560111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38909500Medicaid
WIU72931Medicare UPIN
WI35132Medicare ID - Type Unspecified