Provider Demographics
NPI:1588672299
Name:HAWES, MICHELLE RENE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RENE
Last Name:HAWES
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 1:1977 E WATTLES RD
Mailing Address - Street 2:STE A
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-5047
Mailing Address - Country:US
Mailing Address - Phone:248-524-9100
Mailing Address - Fax:
Practice Address - Street 1:1977 E WATTLES RD
Practice Address - Street 2:STE A
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-5047
Practice Address - Country:US
Practice Address - Phone:248-524-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E0018870OtherBCBS
MI11583511OtherCAQH