Healthcare Provider Details

I. General information

NPI: 1134390909
Provider Name (Legal Business Name): MICHAEL V. CIRILLI D.C. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8683 STUART AVE
MINOCQUA WI
54548-9014
US

IV. Provider business mailing address

8683 STUART AVE
MINOCQUA WI
54548-9014
US

V. Phone/Fax

Practice location:
  • Phone: 715-356-4478
  • Fax: 715-356-7775
Mailing address:
  • Phone: 715-356-4478
  • Fax: 715-356-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateWI

VIII. Authorized Official

Name: MICHAEL VINCENT CIRILLI
Title or Position: OWNER
Credential: DC
Phone: 715-356-4478