Provider Demographics
NPI:1609976877
Name:WELCH, MICHAEL D (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:WELCH
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 1:300 WALNUT ST STE 205
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2258
Mailing Address - Country:US
Mailing Address - Phone:515-246-8621
Mailing Address - Fax:515-246-0093
Practice Address - Street 1:300 WALNUT ST STE 205
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2258
Practice Address - Country:US
Practice Address - Phone:515-246-8621
Practice Address - Fax:515-246-0093
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0265322Medicaid
IA26532Medicare PIN
IAT39392Medicare UPIN