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General NPI Number Information
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NPI Number | 1053597906
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Entity Type | Organization
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Legal Business Name | MICHAELSEN CHIROPRACTIC CENTER, P.C.
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 645 S BROADWAY AVE SUITE 1
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City | TYLER
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State | TX
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Zip | 75701-1676
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Country | US
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Telephone | 903-593-5200
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Fax | 903-535-9412
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Provider Business Mailing Address
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Address Line | 645 S BROADWAY AVE SUITE 1
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City | TYLER
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State | TX
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Zip | 75701-1676
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Country | US
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Telephone | 903-593-5200
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Fax | 903-535-9412
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK R MICHAELSEN
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Credential | D.C.
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Telephone | 903-593-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | F002316
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License Number State | TX
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