Provider Demographics
NPI:1699872903
Name:TRAUB, MICHAEL RAY (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAY
Last Name:TRAUB
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:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-0221
Mailing Address - Country:US
Mailing Address - Phone:262-567-4497
Mailing Address - Fax:262-567-3816
Practice Address - Street 1:N58 W39799 W HWY 16
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066
Practice Address - Country:US
Practice Address - Phone:262-567-4497
Practice Address - Fax:262-567-3716
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38750800Medicaid
WIT63534Medicare UPIN
WI000146046Medicare ID - Type Unspecified