Healthcare Provider Details

I. General information

NPI: 1275519555
Provider Name (Legal Business Name): MICHAEL ANTHONY PHELPS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 E MORGAN ST
MARTINSVILLE IN
46151-1640
US

IV. Provider business mailing address

690 E MORGAN ST
MARTINSVILLE IN
46151-1640
US

V. Phone/Fax

Practice location:
  • Phone: 765-342-2208
  • Fax: 765-342-2327
Mailing address:
  • Phone: 765-342-2208
  • Fax: 765-342-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001309
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: