Provider Demographics
NPI:1326263047
Name:BURT, MICHAEL A (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:BURT
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 1:401 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-1622
Mailing Address - Country:US
Mailing Address - Phone:231-597-9999
Mailing Address - Fax:231-597-1042
Practice Address - Street 1:401 W ELM ST
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-1622
Practice Address - Country:US
Practice Address - Phone:231-597-9999
Practice Address - Fax:231-597-1042
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4440211Medicaid
MIN33800002Medicare PIN
MI0N29030Medicare PIN
U79135Medicare UPIN