Provider Demographics
NPI:1356327555
Name:ERNESTY, MICHAEL DOUGLAS (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:ERNESTY
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:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-0205
Mailing Address - Country:US
Mailing Address - Phone:724-834-7882
Mailing Address - Fax:724-834-7886
Practice Address - Street 1:RR 3 BOX 299P
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-9754
Practice Address - Country:US
Practice Address - Phone:724-834-7882
Practice Address - Fax:724-834-7886
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007889L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA018297780002Medicaid
U82575Medicare UPIN
PA018297780002Medicaid