Provider Demographics
NPI:1114099199
Name:DAWSON, MICHAEL H (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:DAWSON
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 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:82013 DOCTOR CARREON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5832
Practice Address - Country:US
Practice Address - Phone:760-775-6966
Practice Address - Fax:760-342-6882
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19750OtherCHIROPRACTIC LICENSE
CADC0197500Medicare ID - Type UnspecifiedMEDICARE
CADC19750OtherCHIROPRACTIC LICENSE