Provider Demographics
NPI:1790821452
Name:MICHIE, KEVIN JESS (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JESS
Last Name:MICHIE
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 1:3120 REMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2602
Mailing Address - Country:US
Mailing Address - Phone:970-226-6996
Mailing Address - Fax:
Practice Address - Street 1:3120 REMINGTON ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2602
Practice Address - Country:US
Practice Address - Phone:970-226-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU03271Medicare UPIN
COC20213Medicare ID - Type Unspecified