Provider Demographics
NPI:1588701528
Name:NICE, MICHAEL C (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:NICE
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 1:541 KENOSHA ST
Mailing Address - Street 2:
Mailing Address - City:WALWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:53184-9538
Mailing Address - Country:US
Mailing Address - Phone:262-275-1700
Mailing Address - Fax:262-275-8767
Practice Address - Street 1:541 KENOSHA ST
Practice Address - Street 2:
Practice Address - City:WALWORTH
Practice Address - State:WI
Practice Address - Zip Code:53184-9538
Practice Address - Country:US
Practice Address - Phone:262-275-1700
Practice Address - Fax:262-275-8767
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2418 012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor