Provider Demographics
NPI:1851693873
Name:VENNELL, MICHAEL DEWAYNE (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEWAYNE
Last Name:VENNELL
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 1:3501 SONCY ST. STE # 1
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6405
Mailing Address - Country:US
Mailing Address - Phone:806-356-7291
Mailing Address - Fax:806-553-1598
Practice Address - Street 1:3501 SONCY ST. STE # 1
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6405
Practice Address - Country:US
Practice Address - Phone:806-356-7291
Practice Address - Fax:806-553-1598
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11599111NI0013X, 111NN1001X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NN1001XChiropractic ProvidersChiropractorNutrition