Provider Demographics
NPI:1164594693
Name:ABNEY, MICHAEL LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:ABNEY
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 1:101 VISITACION AVE.
Mailing Address - Street 2:
Mailing Address - City:BRISBANE
Mailing Address - State:CA
Mailing Address - Zip Code:94005
Mailing Address - Country:US
Mailing Address - Phone:415-467-3456
Mailing Address - Fax:415-467-3530
Practice Address - Street 1:101 VISITACION AVE
Practice Address - Street 2:
Practice Address - City:BRISBANE
Practice Address - State:CA
Practice Address - Zip Code:94005-1560
Practice Address - Country:US
Practice Address - Phone:415-467-3456
Practice Address - Fax:415-467-3530
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0225650Medicare ID - Type Unspecified