Provider Demographics
NPI:1760456776
Name:ALDRICH, MICHAEL DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEAN
Last Name:ALDRICH
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 1:2304 JERSEY RIDGE RD. STE. 4 LOWER LEVEL
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2378
Mailing Address - Country:US
Mailing Address - Phone:563-441-9696
Mailing Address - Fax:563-344-9444
Practice Address - Street 1:2020 E 11TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-3961
Practice Address - Country:US
Practice Address - Phone:563-441-9696
Practice Address - Fax:563-344-9444
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0229062Medicaid
IA24988OtherWELLMARK BC/BS
IAU84523Medicare UPIN
IA24988OtherWELLMARK BC/BS