Provider Demographics
NPI:1649390527
Name:DOOLEY, MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:DOOLEY
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 1:215 NEEDHAM ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1111
Mailing Address - Country:US
Mailing Address - Phone:209-236-0555
Mailing Address - Fax:
Practice Address - Street 1:215 NEEDHAM ST
Practice Address - Street 2:SUITE D
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1111
Practice Address - Country:US
Practice Address - Phone:209-236-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-27669111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0276690Medicaid
CADC0276690Medicaid