Provider Demographics
NPI:1578586525
Name:ETLINGER, MICHAEL THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:ETLINGER
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 1:1927 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-6009
Mailing Address - Country:US
Mailing Address - Phone:734-324-2400
Mailing Address - Fax:734-324-2404
Practice Address - Street 1:1927 EUREKA RD
Practice Address - Street 2:1927 EUREKA RD
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-6009
Practice Address - Country:US
Practice Address - Phone:734-324-2400
Practice Address - Fax:734-324-2404
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2594219Medicaid
T74542Medicare UPIN
OH25087Medicare ID - Type Unspecified