Michael Joseph Croninger Jr., D.C.
Individual provider Active NPI Chiropractor · Appleton, WI
NPI 1477876134 · NPPES record last updated Apr 24, 2019
Key facts
- NPI
- 1477876134
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4552-012 (WI)
- Practice address
- 4070 W Spencer St
Appleton, WI 54914-4015 - Phone
- (920) 731-3255
- Fax
- (920) 731-3357
- NPI assigned
- Mar 10, 2010
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110104000660 | WI | Practitioner - Chiropractic | 3971792193 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4552-012 | WI | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gateway Chiropractic S C | Chiropractor | Current |
Accepting new patients |
| Genesis Family Chiropractic SC | Chiropractor | Past |
Accepting new patients |
Locations
4070 W Spencer St
Appleton, WI 54914
Phone (920) 731-3255
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 4552-012 | WI | Yes |
Addresses
Primary practice location
4070 W Spencer St
Appleton, WI 54914-4015
Mailing address
4070 W Spencer St
Appleton, WI 54914-4015
Phone (920) 420-5796
Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.