Provider Demographics
NPI:1265844922
Name:MAHAN, MICHAEL ORIN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ORIN
Last Name:MAHAN
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 1:1606 S COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76834-5018
Mailing Address - Country:US
Mailing Address - Phone:325-625-4163
Mailing Address - Fax:
Practice Address - Street 1:1606 S COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:TX
Practice Address - Zip Code:76834-5018
Practice Address - Country:US
Practice Address - Phone:325-625-4163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor