Provider Demographics
NPI:1376554485
Name:COLE, MICHAEL ROBERT (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:COLE
Suffix:
Gender:M
Credentials:CHIROPRACTOR
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 149
Mailing Address - Street 2:201 S. MAIN ST
Mailing Address - City:VANDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:63382-0149
Mailing Address - Country:US
Mailing Address - Phone:573-594-2663
Mailing Address - Fax:573-594-2663
Practice Address - Street 1:201 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:MO
Practice Address - Zip Code:63382-0149
Practice Address - Country:US
Practice Address - Phone:573-594-2663
Practice Address - Fax:573-594-2663
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
222567OtherHEALTHLINK
19025OtherBLUE CROSS
222567OtherHEALTHLINK
U41828Medicare UPIN