Provider Demographics
NPI:1750303988
Name:MICHELE, DENISE (DC)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:MICHELE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:MICHELE
Other - Last Name:PAINCHAUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1300 N VERDUGO RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-2805
Mailing Address - Country:US
Mailing Address - Phone:818-241-2436
Mailing Address - Fax:
Practice Address - Street 1:1300 N VERDUGO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-2805
Practice Address - Country:US
Practice Address - Phone:818-241-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC21460Medicare PIN
CAU28905Medicare UPIN