Provider Demographics
NPI:1225174741
Name:LAU, MICHAEL J (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:LAU
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 1:6130 S MAPLEWOOD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-2134
Mailing Address - Country:US
Mailing Address - Phone:918-481-9200
Mailing Address - Fax:918-481-1125
Practice Address - Street 1:6130 S MAPLEWOOD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-2134
Practice Address - Country:US
Practice Address - Phone:918-481-9200
Practice Address - Fax:918-481-1125
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
248301402Medicare ID - Type Unspecified
U92846Medicare UPIN