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NPI Code Detail

MEDICARE: MICHAEL R. IZQUIERDO D.C.

MEDICARE: MICHAEL R. IZQUIERDO D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor3664OH

General Provider Information

NPI Number : 1407944663
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL R. IZQUIERDO D.C.
Provider Business Mailing Address
First Line : 14524 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-4317
Country : US
Telephone Number : 216-521-7777
Fax Number : 216-521-7778
Provider Business Practice Location Address
First Line : 14524 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-4317
Country : US
Telephone Number : 216-521-7777
Fax Number : 216-521-7778
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 10/24/2007

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