Provider Demographics
NPI:1750326005
Name:JOHR, MICHAEL CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:JOHR
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 1:27200 HARPER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1909
Mailing Address - Country:US
Mailing Address - Phone:586-774-6332
Mailing Address - Fax:586-774-5144
Practice Address - Street 1:27200 HARPER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1909
Practice Address - Country:US
Practice Address - Phone:586-774-6332
Practice Address - Fax:586-774-5144
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E016940OtherBLUE CROSS
MI3522458494OtherCOMMERCIAL
MI0P18870Medicare ID - Type Unspecified