Provider Demographics
NPI:1467450940
Name:WRIGHT, MICHELLE R (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:R
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:R
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1448 HOUSELS RUN RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:PA
Mailing Address - Zip Code:17847-8535
Mailing Address - Country:US
Mailing Address - Phone:570-524-2242
Mailing Address - Fax:570-524-2242
Practice Address - Street 1:1448 HOUSELS RUN RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-8535
Practice Address - Country:US
Practice Address - Phone:570-524-2242
Practice Address - Fax:570-524-2242
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006313L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001544544Medicaid
PAKE802881Medicare ID - Type UnspecifiedPROVIDER NUMBER
PA58254Medicare UPIN