Provider Demographics
NPI:1245388719
Name:EVERETT, MICHAEL KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KENNETH
Last Name:EVERETT
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 1:519 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:WALNUTPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18088-9653
Mailing Address - Country:US
Mailing Address - Phone:610-760-1700
Mailing Address - Fax:610-760-1757
Practice Address - Street 1:519 WILLOW RD
Practice Address - Street 2:
Practice Address - City:WALNUTPORT
Practice Address - State:PA
Practice Address - Zip Code:18088-9653
Practice Address - Country:US
Practice Address - Phone:610-760-1700
Practice Address - Fax:610-760-1757
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005640L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0525470OtherAETNA
PA1436999OtherHIGHMARK BLUE SHIELD
PA50022061OtherCAPITAL BLUE CROSS
PAO36999OtherAMERIHEALTH
PAU58530Medicare UPIN
PA1436999OtherHIGHMARK BLUE SHIELD