Provider Demographics
NPI:1659371987
Name:COMSTOCK, MICHAEL RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAY
Last Name:COMSTOCK
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:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:HEDRICK
Mailing Address - State:IA
Mailing Address - Zip Code:52563-0243
Mailing Address - Country:US
Mailing Address - Phone:641-653-2311
Mailing Address - Fax:
Practice Address - Street 1:202 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HEDRICK
Practice Address - State:IA
Practice Address - Zip Code:52563-9321
Practice Address - Country:US
Practice Address - Phone:641-653-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0206557Medicaid
IA17517OtherWELLMARK BC/BS
IA0206557Medicaid
IA350052527Medicare ID - Type UnspecifiedRAILROAD MEDICARE