Provider Demographics
NPI:1548393028
Name:MICHAEL, MARIOS C (DC, CNS, DAAPM)
Entity Type:Individual
Prefix:DR
First Name:MARIOS
Middle Name:C
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:DC, CNS, DAAPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 N. LAKE AVE.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101
Mailing Address - Country:US
Mailing Address - Phone:626-440-7406
Mailing Address - Fax:866-379-0950
Practice Address - Street 1:424 N. LAKE AVE.
Practice Address - Street 2:SUITE 102
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:626-440-7406
Practice Address - Fax:866-379-0950
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27129111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0271290OtherBLUE SHEILD
CADC0271290OtherBLUE SHEILD
CABA236ZMedicare PIN