Provider Demographics
NPI:1053505099
Name:MICHAEL JOSEPH
Entity Type:Organization
Organization Name:MICHAEL JOSEPH
Other - Org Name:PAIN RELIEF CLINIC OF MARIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-444-0700
Mailing Address - Street 1:PO BOX 6382
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-6832
Mailing Address - Country:US
Mailing Address - Phone:415-444-0700
Mailing Address - Fax:415-444-0771
Practice Address - Street 1:1050 NORTHGATE DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2526
Practice Address - Country:US
Practice Address - Phone:415-444-0700
Practice Address - Fax:415-444-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty