Provider Demographics
NPI:1306846480
Name:MASSEY, MICHAEL D (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:MASSEY
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 1:740 TELL ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-5169
Mailing Address - Country:US
Mailing Address - Phone:423-745-8500
Mailing Address - Fax:423-745-8501
Practice Address - Street 1:740 TELL ST
Practice Address - Street 2:SUITE 400
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-5169
Practice Address - Country:US
Practice Address - Phone:423-745-8500
Practice Address - Fax:423-745-8501
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3675146Medicare ID - Type Unspecified
TNT86116Medicare UPIN