Provider Demographics
NPI:1346245727
Name:FAULKNER, MICHAEL KEITH (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KEITH
Last Name:FAULKNER
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 1:10513 LINCOLN TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-1911
Mailing Address - Country:US
Mailing Address - Phone:618-398-7550
Mailing Address - Fax:618-398-7553
Practice Address - Street 1:10513 LINCOLN TRL
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-1911
Practice Address - Country:US
Practice Address - Phone:618-398-7550
Practice Address - Fax:618-398-7553
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T37221Medicare UPIN
ILK27552Medicare PIN