Provider Demographics
NPI:1225000813
Name:POWELL, MICHAEL K (DC DACNB)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:POWELL
Suffix:
Gender:M
Credentials:DC DACNB
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:K
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, DACNB
Mailing Address - Street 1:1310 TOWER LN NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7488
Mailing Address - Country:US
Mailing Address - Phone:319-366-2518
Mailing Address - Fax:319-366-5002
Practice Address - Street 1:1310 TOWER LN NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-7488
Practice Address - Country:US
Practice Address - Phone:319-366-2518
Practice Address - Fax:319-366-5002
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05946111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA57354OtherBLUE CROSS BLUE SHIELD