Healthcare Provider Details

I. General information

NPI: 1275619397
Provider Name (Legal Business Name): JOHN RYAN MICHAELS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W HOWARD ST
HIBBING MN
55746-1548
US

IV. Provider business mailing address

115 W HOWARD ST
HIBBING MN
55746-1548
US

V. Phone/Fax

Practice location:
  • Phone: 218-262-3315
  • Fax:
Mailing address:
  • Phone: 218-262-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1812
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: