Provider Demographics
NPI:1801976279
Name:HAASE, JOHN MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:HAASE
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 1:4200 UNIVERSITY AVE STE 2100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2172
Mailing Address - Country:US
Mailing Address - Phone:608-231-3900
Mailing Address - Fax:608-231-6800
Practice Address - Street 1:4200 UNIVERSITY AVE STE 2100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2172
Practice Address - Country:US
Practice Address - Phone:608-231-3900
Practice Address - Fax:608-231-6800
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1647111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38767600Medicaid
WI38767600Medicaid
WIT62086Medicare UPIN
WI000070143Medicare ID - Type Unspecified