Provider Demographics
NPI:1578612917
Name:DORITY, MICHAEL LYNN (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LYNN
Last Name:DORITY
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 1063
Mailing Address - Street 2:215 WEST 29TH STREET SUITE B
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-1063
Mailing Address - Country:US
Mailing Address - Phone:308-234-6900
Mailing Address - Fax:
Practice Address - Street 1:215 WEST 29TH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3430
Practice Address - Country:US
Practice Address - Phone:308-234-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE83024422000Medicaid
NE091506Medicare ID - Type Unspecified