Provider Demographics
NPI:1790811511
Name:WARREN, MICHAEL L (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:WARREN
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 1:3560 NATIONAL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4008
Mailing Address - Country:US
Mailing Address - Phone:541-734-7333
Mailing Address - Fax:541-734-8802
Practice Address - Street 1:3560 NATIONAL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4008
Practice Address - Country:US
Practice Address - Phone:541-734-7333
Practice Address - Fax:541-734-8802
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1710930151OtherNPI# FOR ORGANIZATION
OR131254Medicare PIN
OR131253Medicare PIN
OR1710930151OtherNPI# FOR ORGANIZATION