Provider Demographics
NPI:1518038777
Name:COATS, MICHELLE R (DC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:COATS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15027 W BELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3216
Mailing Address - Country:US
Mailing Address - Phone:623-215-4107
Mailing Address - Fax:
Practice Address - Street 1:15027 W BELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3216
Practice Address - Country:US
Practice Address - Phone:623-215-4107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7436111NR0400X
AZ4122111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZV06523Medicare UPIN
AZ105446Medicare ID - Type UnspecifiedGROUP NUMBER