Provider Demographics
NPI:1093801946
Name:MCINTYRE, MICHAEL EDWARD (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:MCINTYRE
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 1:487 N HIGHLAND ST APT 14
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-4575
Mailing Address - Country:US
Mailing Address - Phone:901-728-7964
Mailing Address - Fax:
Practice Address - Street 1:487 N HIGHLAND ST APT 14
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-4575
Practice Address - Country:US
Practice Address - Phone:901-728-7964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010106111N00000X
OHDC4674111N00000X
TNDC1975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V02107Medicare UPIN
3973190Medicare ID - Type Unspecified
3973190Medicare ID - Type Unspecified
TN4099633OtherBCBS