Provider Demographics
NPI:1467460394
Name:DORN, MICHAEL (DC DOCTOR OF CHIROPR)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:DORN
Suffix:
Gender:M
Credentials:DC DOCTOR OF CHIROPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1834
Mailing Address - Country:US
Mailing Address - Phone:410-662-4476
Mailing Address - Fax:410-662-9884
Practice Address - Street 1:3914 HICKORY AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1834
Practice Address - Country:US
Practice Address - Phone:410-662-4476
Practice Address - Fax:410-662-9884
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD501922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1091702OtherHIPPA
U89228Medicare UPIN
MD254M338FMedicare ID - Type Unspecified