Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC27129 | CA |
NPI | 1548393028 |
---|---|
Provider Name | Dr. Marios C Michael |
First Address | Pasadena, CA 91101 |
Second Address | Pasadena, CA 91101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 15/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0271290 | BLUE SHEILD (01) | CA |
U86296 | (02) | CA |