Provider Demographics
NPI:1902027295
Name:BIENICK, MICHELLE DAWN (ND)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DAWN
Last Name:BIENICK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 HUMBUG CREEK RD
Mailing Address - Street 2:
Mailing Address - City:APPLEGATE
Mailing Address - State:OR
Mailing Address - Zip Code:97530
Mailing Address - Country:US
Mailing Address - Phone:541-846-0656
Mailing Address - Fax:
Practice Address - Street 1:1881 HUMBUG CREEK RD
Practice Address - Street 2:
Practice Address - City:APPLEGATE
Practice Address - State:OR
Practice Address - Zip Code:97530
Practice Address - Country:US
Practice Address - Phone:541-846-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1182172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181551Medicaid