Healthcare Provider Details

I. General information

NPI: 1043217706
Provider Name (Legal Business Name): MICHAEL JUDE MILBAUER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 2ND ST S
SARTELL MN
56377-1977
US

IV. Provider business mailing address

100 2ND ST S PO BOX 296
SARTELL MN
56377-1977
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-2600
  • Fax: 320-251-4763
Mailing address:
  • Phone: 320-251-2600
  • Fax: 320-251-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2895
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: