Healthcare Provider Details

I. General information

NPI: 1679645659
Provider Name (Legal Business Name): MICHAEL IAN DELA CRUZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MAIN ST SUITE 2
NORWAY MI
49870-1270
US

IV. Provider business mailing address

400 MAIN ST SUITE 2
NORWAY MI
49870-1270
US

V. Phone/Fax

Practice location:
  • Phone: 906-563-5400
  • Fax:
Mailing address:
  • Phone: 906-563-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008712
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: