Provider Demographics
NPI:1275619397
Name:MICHAELS, JOHN RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RYAN
Last Name:MICHAELS
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 1:115 W HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-1548
Mailing Address - Country:US
Mailing Address - Phone:218-262-3315
Mailing Address - Fax:
Practice Address - Street 1:115 W HOWARD ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-1548
Practice Address - Country:US
Practice Address - Phone:218-262-3315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1812111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C955MIOtherBLUE CROSS BLUE SHIELD
MNT65508Medicare UPIN