Provider Demographics
NPI:1588831358
Name:MICHAEL W. NEELY, D.C.
Entity type:Organization
Organization Name:MICHAEL W. NEELY, D.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-943-2940
Mailing Address - Street 1:3525 ENSIGN RD NE
Mailing Address - Street 2:SUITE N
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5065
Mailing Address - Country:US
Mailing Address - Phone:360-943-2940
Mailing Address - Fax:888-381-3726
Practice Address - Street 1:3525 ENSIGN RD NE
Practice Address - Street 2:SUITE N
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5065
Practice Address - Country:US
Practice Address - Phone:360-943-2940
Practice Address - Fax:888-381-3726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026060Medicaid
WAG8809595Medicare PIN