Provider Demographics
NPI:1124227418
Name:ABROMOVITZ, MICHAEL WALDEN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WALDEN
Last Name:ABROMOVITZ
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 1:1395 E WARNER RD
Mailing Address - Street 2:STE. C102
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3160
Mailing Address - Country:US
Mailing Address - Phone:480-635-8228
Mailing Address - Fax:480-635-9972
Practice Address - Street 1:1395 E WARNER RD
Practice Address - Street 2:STE. C102
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3160
Practice Address - Country:US
Practice Address - Phone:480-635-8228
Practice Address - Fax:480-635-9972
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7567111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ106554Medicare PIN