Provider Demographics
NPI:1659368710
Name:DEMCHAK, MICHAEL J (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DEMCHAK
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 1:2699 LEE RD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1753
Mailing Address - Country:US
Mailing Address - Phone:407-960-3775
Mailing Address - Fax:407-960-3652
Practice Address - Street 1:2699 LEE RD
Practice Address - Street 2:SUITE 505
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1753
Practice Address - Country:US
Practice Address - Phone:407-960-3775
Practice Address - Fax:407-960-3652
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381867500Medicaid
FLK6537Medicare PIN