Provider Demographics
NPI:1073510434
Name:DIMASI, JOHN MICKY (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICKY
Last Name:DIMASI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35525 GARFIELD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-5521
Mailing Address - Country:US
Mailing Address - Phone:586-477-1800
Mailing Address - Fax:586-477-1815
Practice Address - Street 1:35525 GARFIELD RD
Practice Address - Street 2:SUITE B
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-5521
Practice Address - Country:US
Practice Address - Phone:586-477-1800
Practice Address - Fax:586-477-1815
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU35445Medicare UPIN
MIMI4117001Medicare PIN