Provider Demographics
NPI:1679645659
Name:DELA CRUZ, MICHAEL IAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:IAN
Last Name:DELA CRUZ
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 1:400 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORWAY
Mailing Address - State:MI
Mailing Address - Zip Code:49870-1270
Mailing Address - Country:US
Mailing Address - Phone:906-563-5400
Mailing Address - Fax:
Practice Address - Street 1:400 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORWAY
Practice Address - State:MI
Practice Address - Zip Code:49870-1270
Practice Address - Country:US
Practice Address - Phone:906-563-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008712111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932231OtherBCBS PROVIDER NUMBER
ILU96724Medicare UPIN
IL206831Medicare ID - Type UnspecifiedPROVIDER NUMBER