Healthcare Provider Details

I. General information

NPI: 1740352319
Provider Name (Legal Business Name): MICHAEL KUK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25096 CENTER RIDGE RD
WESTLAKE OH
44145-4113
US

IV. Provider business mailing address

25096 CENTER RIDGE RD
WESTLAKE OH
44145-4113
US

V. Phone/Fax

Practice location:
  • Phone: 440-892-5540
  • Fax:
Mailing address:
  • Phone: 440-892-5540
  • Fax: 440-892-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2647
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: