Provider Demographics
NPI:1114063658
Name:DZIRBOWICZ, MICHAEL HENRY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HENRY
Last Name:DZIRBOWICZ
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 1:6739 FULTON ST E
Mailing Address - Street 2:SUITE C-20
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8138
Mailing Address - Country:US
Mailing Address - Phone:616-676-2888
Mailing Address - Fax:616-676-4299
Practice Address - Street 1:6739 FULTON ST E
Practice Address - Street 2:SUITE C-20
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8138
Practice Address - Country:US
Practice Address - Phone:616-676-2888
Practice Address - Fax:616-676-4299
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMD008554OtherCOMMERCIAL INSURANCE
MI950D151680OtherBLUE CROSS ID NUMBER
MI950D151680OtherBLUE CROSS ID NUMBER