Provider Demographics
NPI:1164725719
Name:LORD, MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LORD
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 1:2797 UNION ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-3807
Mailing Address - Country:US
Mailing Address - Phone:415-441-8446
Mailing Address - Fax:415-441-8451
Practice Address - Street 1:2797 UNION ST
Practice Address - Street 2:SUITE C
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-3807
Practice Address - Country:US
Practice Address - Phone:415-441-8446
Practice Address - Fax:415-441-8451
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31737111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician