Provider Demographics
NPI:1346247673
Name:JAJUGA, MICHAEL PATRICK (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:JAJUGA
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S BYRNE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3459
Mailing Address - Country:US
Mailing Address - Phone:419-389-1721
Mailing Address - Fax:419-389-1768
Practice Address - Street 1:1515 S BYRNE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3458
Practice Address - Country:US
Practice Address - Phone:419-389-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005740111N00000X
OHDC.1699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3133969Medicaid
OH0977671Medicaid
OH0977671Medicaid