Provider Demographics
NPI:1184686065
Name:SIROIS, MICHELLE GRAY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:GRAY
Last Name:SIROIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-1268
Mailing Address - Country:US
Mailing Address - Phone:573-729-5321
Mailing Address - Fax:573-729-1010
Practice Address - Street 1:504 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-1268
Practice Address - Country:US
Practice Address - Phone:573-729-5321
Practice Address - Fax:573-729-1010
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990001535Medicare ID - Type UnspecifiedMEDICARE NUMBER