Provider Demographics
NPI:1346332871
Name:APPLEBY, MICHAEL GORDON (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GORDON
Last Name:APPLEBY
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 1:2545 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17103-1769
Mailing Address - Country:US
Mailing Address - Phone:717-236-5292
Mailing Address - Fax:717-236-5292
Practice Address - Street 1:2545 WALNUT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17103-1769
Practice Address - Country:US
Practice Address - Phone:717-236-5292
Practice Address - Fax:717-236-5292
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001664L111N00000X, 111NS0005X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07629317Medicaid
IAA05951OtherSTATE LICENSE INACTIVE
PADC001664LOtherSTATE LICENSE
PADC001664LOtherSTATE LICENSE
IAA05951OtherSTATE LICENSE [INACTIVE]