Provider Demographics
NPI:1366496127
Name:MEDLIN, MICHEAL GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:GREGORY
Last Name:MEDLIN
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 1:132 W BANKHEAD ST STE B
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3330
Mailing Address - Country:US
Mailing Address - Phone:662-534-6636
Mailing Address - Fax:
Practice Address - Street 1:132 W BANKHEAD ST STE B
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3330
Practice Address - Country:US
Practice Address - Phone:662-534-6636
Practice Address - Fax:662-534-6639
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006169111N00000X
MS0882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor