Healthcare Provider Details

I. General information

NPI: 1639249758
Provider Name (Legal Business Name): MICHAEL J PAINTER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3478 MAIN ST
OAKLEY CA
94561-3137
US

IV. Provider business mailing address

3478 MAIN ST
OAKLEY CA
94561-3137
US

V. Phone/Fax

Practice location:
  • Phone: 925-625-1881
  • Fax: 925-625-4769
Mailing address:
  • Phone: 925-625-1881
  • Fax: 925-625-4769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC151030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: