Provider Demographics
NPI:1164615944
Name:MICHLIN, STEPHEN CHRISTOPHER (DC, BCAO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CHRISTOPHER
Last Name:MICHLIN
Suffix:
Gender:M
Credentials:DC, BCAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6324 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5418
Mailing Address - Country:US
Mailing Address - Phone:817-810-9111
Mailing Address - Fax:817-506-1809
Practice Address - Street 1:6324 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5418
Practice Address - Country:US
Practice Address - Phone:817-810-9111
Practice Address - Fax:817-506-1809
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor