Provider Demographics
NPI:1275640005
Name:MOUNTAIN, MICHAEL K (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:MOUNTAIN
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 1:7801 MISSION CENTER CT
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1313
Mailing Address - Country:US
Mailing Address - Phone:619-692-0712
Mailing Address - Fax:619-692-0329
Practice Address - Street 1:7801 MISSION CENTER CT
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1313
Practice Address - Country:US
Practice Address - Phone:619-692-0712
Practice Address - Fax:619-692-0329
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25020111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU69770Medicare UPIN
CADC25020Medicare ID - Type UnspecifiedCHIROPRACTOR