Provider Demographics
NPI:1871642330
Name:JOSEPH A MAYO JR DC PC
Entity Type:Organization
Organization Name:JOSEPH A MAYO JR DC PC
Other - Org Name:MICHIGAN CENTER CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:517-764-5305
Mailing Address - Street 1:4640 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49254-1042
Mailing Address - Country:US
Mailing Address - Phone:517-764-5305
Mailing Address - Fax:517-764-5417
Practice Address - Street 1:4640 PAGE AVE
Practice Address - Street 2:
Practice Address - City:MICHIGAN CENTER
Practice Address - State:MI
Practice Address - Zip Code:49254-1042
Practice Address - Country:US
Practice Address - Phone:517-764-5305
Practice Address - Fax:517-764-5417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1947397Medicaid
MIOC85028Medicare PIN
MIT32939Medicare UPIN