Provider Demographics
NPI:1730469412
Name:DANAHER, MICHAEL DEVERELL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEVERELL
Last Name:DANAHER
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 1:104 ASSEMBLY CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5090
Mailing Address - Country:US
Mailing Address - Phone:919-618-3008
Mailing Address - Fax:
Practice Address - Street 1:930 SE CARY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7419
Practice Address - Country:US
Practice Address - Phone:919-851-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor