Provider Demographics
NPI:1871668426
Name:HURST, MICHAEL TROY (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TROY
Last Name:HURST
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 1:5435 BALBOA BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1576
Mailing Address - Country:US
Mailing Address - Phone:818-345-9100
Mailing Address - Fax:818-345-9104
Practice Address - Street 1:5435 BALBOA BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1508
Practice Address - Country:US
Practice Address - Phone:818-345-9100
Practice Address - Fax:818-345-9104
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V02015Medicare ID - Type Unspecified