Provider Demographics
NPI:1598121428
Name:IJOMAH, MICHAEL CHIKEZIE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHIKEZIE
Last Name:IJOMAH
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 1:126 OAK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-1970
Mailing Address - Country:US
Mailing Address - Phone:860-502-5908
Mailing Address - Fax:
Practice Address - Street 1:381 HOPMEADOW ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06089
Practice Address - Country:US
Practice Address - Phone:860-413-2547
Practice Address - Fax:860-413-2549
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor