Provider Demographics
NPI:1770601791
Name:DR MICHAEL W ZOELLE SC
Entity type:Organization
Organization Name:DR MICHAEL W ZOELLE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:ZOELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-465-6040
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2216-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38798400Medicaid
WI1487696571OtherNPI
WI1487696571OtherNPI
WI38798400Medicaid