Provider Demographics
NPI:1669489720
Name:HEWITT, MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:HEWITT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1479
Mailing Address - Country:US
Mailing Address - Phone:734-433-1376
Mailing Address - Fax:734-433-1388
Practice Address - Street 1:1307 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1479
Practice Address - Country:US
Practice Address - Phone:734-433-1376
Practice Address - Fax:734-433-1388
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4605053Medicaid
P00142154OtherMEDICARE RAILROAD
MI4605053Medicaid
MI0M21740Medicare ID - Type Unspecified