Provider Demographics
NPI:1235298431
Name:MICHAEL, ANN OLDHAM (DC)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:OLDHAM
Last Name:MICHAEL
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 1:905 MAIN ST
Mailing Address - Street 2:SUITE 613
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-5810
Mailing Address - Country:US
Mailing Address - Phone:541-883-2263
Mailing Address - Fax:
Practice Address - Street 1:905 MAIN ST
Practice Address - Street 2:SUITE 613
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-5810
Practice Address - Country:US
Practice Address - Phone:541-883-2263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2929111N00000X
CADC 27485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000074444Medicare ID - Type Unspecified