Provider Demographics
NPI:1750304887
Name:SCHWANGER, MICHAEL LARRY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LARRY
Last Name:SCHWANGER
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 1:6588 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9431
Mailing Address - Country:US
Mailing Address - Phone:734-856-6411
Mailing Address - Fax:734-854-2540
Practice Address - Street 1:6588 SECOR RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9431
Practice Address - Country:US
Practice Address - Phone:734-856-6411
Practice Address - Fax:734-854-2540
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00960OtherPARAMOUNT
OH0214682Medicaid
MI1391033Medicaid
MI1391033Medicaid