1629139779 NPI number — DR. MICHAEL WILLIAM BARTELL D.C.

Table of content: DR. MICHAEL WILLIAM BARTELL D.C. (NPI 1629139779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629139779 NPI number — DR. MICHAEL WILLIAM BARTELL D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTELL
Provider First Name:
MICHAEL
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629139779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 6TH AVE, SUITE 103
Provider Second Line Business Mailing Address:
PO BOX 113
Provider Business Mailing Address City Name:
GLENWOOD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-634-3000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16151 STATE HIGHWAY 29
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GLENWOOD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56334-2142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-634-3000
Provider Business Practice Location Address Fax Number:
320-634-1948
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4239 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 013916500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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