Provider Demographics
NPI:1073664686
Name:BLENDL, MICHAEL JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:BLENDL
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 1:37211 HARPER AVE
Mailing Address - Street 2:SUITE 9B
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3074
Mailing Address - Country:US
Mailing Address - Phone:586-463-3103
Mailing Address - Fax:586-463-5688
Practice Address - Street 1:37211 HARPER AVE
Practice Address - Street 2:SUITE 9B
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-3074
Practice Address - Country:US
Practice Address - Phone:586-463-3103
Practice Address - Fax:586-463-5688
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004398111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2113783Medicaid
MI0E05124Medicare ID - Type UnspecifiedMEDICARE ID