Provider Demographics
NPI:1497888523
Name:JAMIESON, MICHAEL DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:JAMIESON
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:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:RI
Mailing Address - Zip Code:02898-0212
Mailing Address - Country:US
Mailing Address - Phone:401-539-2617
Mailing Address - Fax:401-539-3148
Practice Address - Street 1:39 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:RI
Practice Address - Zip Code:02898-1101
Practice Address - Country:US
Practice Address - Phone:401-539-2617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor