Provider Demographics
NPI:1598754046
Name:PRATT, MICHAEL W (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:PRATT
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 1:6434 N COLLEGE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-6600
Mailing Address - Country:US
Mailing Address - Phone:317-251-5812
Mailing Address - Fax:317-251-5885
Practice Address - Street 1:6434 N COLLEGE AVE
Practice Address - Street 2:STE D
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-6602
Practice Address - Country:US
Practice Address - Phone:317-251-5812
Practice Address - Fax:317-251-5885
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001789A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T34464Medicare UPIN
IN035950Medicare ID - Type Unspecified