Provider Demographics
NPI:1760501332
Name:MURPHY, MIKE L (DC)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:L
Last Name:MURPHY
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 1:2675 CLEVELAND AVENUE
Mailing Address - Street 2:#11
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2764
Mailing Address - Country:US
Mailing Address - Phone:707-526-7790
Mailing Address - Fax:
Practice Address - Street 1:2675 CLEVELAND AVENUE
Practice Address - Street 2:#11
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2764
Practice Address - Country:US
Practice Address - Phone:707-526-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0138470Medicaid
CADC0138470Medicaid
T05158Medicare UPIN