Healthcare Provider Details

I. General information

NPI: 1932106523
Provider Name (Legal Business Name): MICHAEL T CEREFIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 S EMERSON AVE STE Q
INDIANAPOLIS IN
46237-8669
US

IV. Provider business mailing address

7855 S EMERSON AVE STE Q
INDIANAPOLIS IN
46237-8669
US

V. Phone/Fax

Practice location:
  • Phone: 317-884-2636
  • Fax: 317-884-2633
Mailing address:
  • Phone: 317-884-2636
  • Fax: 317-884-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001590A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: