MEDICARE: DR. MICHAEL C. NICE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2418 012	WI

General Provider Information

NPI Number	:	1588701528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL C. NICE D.C.

Provider Business Mailing Address
First Line	:	541 KENOSHA ST
Second Line	:
City	:	WALWORTH
State	:	WI
Zip	:	53184-9538
Country	:	US
Telephone Number	:	262-275-1700
Fax Number	:	262-275-8767

Provider Business Practice Location Address
First Line	:	541 KENOSHA ST
Second Line	:
City	:	WALWORTH
State	:	WI
Zip	:	53184-9538
Country	:	US
Telephone Number	:	262-275-1700
Fax Number	:	262-275-8767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	08/22/2019

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