Provider Demographics
NPI:1275519555
Name:PHELPS, MICHAEL ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:PHELPS
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 1:690 E MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-1640
Mailing Address - Country:US
Mailing Address - Phone:765-342-2208
Mailing Address - Fax:765-342-2327
Practice Address - Street 1:690 E MORGAN ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1640
Practice Address - Country:US
Practice Address - Phone:765-342-2208
Practice Address - Fax:765-342-2327
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100186900AMedicaid
INU22964Medicare UPIN
IN100186900AMedicaid