Provider Demographics
NPI:1285664474
Name:YORK, MICHAEL KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KEITH
Last Name:YORK
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 1:41 KEENAN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2904
Mailing Address - Country:US
Mailing Address - Phone:720-988-5681
Mailing Address - Fax:
Practice Address - Street 1:515 MOODY ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-0506
Practice Address - Country:US
Practice Address - Phone:781-647-5550
Practice Address - Fax:781-893-7077
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45845Medicare ID - Type Unspecified