Provider Demographics
NPI:1376763417
Name:COONS, MICHAEL BENNETT
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BENNETT
Last Name:COONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-2008
Mailing Address - Country:US
Mailing Address - Phone:636-456-2151
Mailing Address - Fax:
Practice Address - Street 1:304 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-2008
Practice Address - Country:US
Practice Address - Phone:636-456-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE004006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor