Provider Demographics
NPI:1629253158
Name:HAWKINSON, MICHAEL GEORGE (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:HAWKINSON
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LABADIE
Mailing Address - State:MO
Mailing Address - Zip Code:63055-1640
Mailing Address - Country:US
Mailing Address - Phone:636-742-4735
Mailing Address - Fax:
Practice Address - Street 1:30 LAKE RD
Practice Address - Street 2:
Practice Address - City:LABADIE
Practice Address - State:MO
Practice Address - Zip Code:63055-1640
Practice Address - Country:US
Practice Address - Phone:636-742-4735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE0005309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor