Provider Demographics
NPI:1225188402
Name:MICHELLI, RONALD A (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:MICHELLI
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 1:4 WEBER AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1742
Mailing Address - Country:US
Mailing Address - Phone:516-599-3999
Mailing Address - Fax:516-887-8106
Practice Address - Street 1:4 WEBER AVE
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1742
Practice Address - Country:US
Practice Address - Phone:516-599-3999
Practice Address - Fax:516-887-8106
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT52365Medicare UPIN