Provider Demographics
NPI:1487696571
Name:ZOELLE, MICHAEL W (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:ZOELLE
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 1:2420 FINGER RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-4210
Mailing Address - Country:US
Mailing Address - Phone:920-465-6040
Mailing Address - Fax:920-465-4464
Practice Address - Street 1:2420 FINGER RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-4210
Practice Address - Country:US
Practice Address - Phone:920-465-6040
Practice Address - Fax:920-465-4464
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2216-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1770601791OtherGROUP NPI
WI38798400Medicaid
WI35799Medicare ID - Type Unspecified