Healthcare Provider Details

I. General information

NPI: 1033535596
Provider Name (Legal Business Name): MICHAEL LEE MCPHERSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11705 BOYETTE RD # 154
RIVERVIEW FL
33569-5533
US

IV. Provider business mailing address

PO BOX 135942
CLERMONT FL
34713-5942
US

V. Phone/Fax

Practice location:
  • Phone: 888-788-8345
  • Fax: 888-788-8345
Mailing address:
  • Phone: 727-475-2608
  • Fax: 888-788-8345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH11147
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH11147
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH11147
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11147
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: