Healthcare Provider Details

I. General information

NPI: 1275686834
Provider Name (Legal Business Name): MICHAEL VINCENT CIRILLI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL VINCENT CIRILLI DC

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
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: 715-956-4478
  • Fax: 715-356-7775
Mailing address:
  • Phone: 715-956-4478
  • Fax: 715-356-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2302
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: