Provider Demographics
NPI:1407812258
Name:HILL, MICHAEL LEE (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:HILL
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 1:298 S NOVA RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-0412
Mailing Address - Country:US
Mailing Address - Phone:386-226-0081
Mailing Address - Fax:386-226-2148
Practice Address - Street 1:298 S NOVA RD
Practice Address - Street 2:SUITE E
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-0412
Practice Address - Country:US
Practice Address - Phone:386-226-0081
Practice Address - Fax:386-226-2148
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL69024OtherBCBS
FLAC926OtherMEDICARE GROUP
FLU6818YOtherMEDICARE ID
FL382027100Medicaid
FL69024OtherBCBS
FLAC926OtherMEDICARE GROUP