Provider Demographics
NPI:1922030774
Name:HUSMILLO, MICHAEL O (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:O
Last Name:HUSMILLO
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 1:1393 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1779
Mailing Address - Country:US
Mailing Address - Phone:248-224-1577
Mailing Address - Fax:
Practice Address - Street 1:5098 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2919
Practice Address - Country:US
Practice Address - Phone:810-733-1261
Practice Address - Fax:810-733-1274
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMH008745111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0999791OtherHEALTH PLUS
MI4308993OtherCIGNA
MI950B51223-0OtherBLUE CROSS OF MICHIGAN
T32760Medicare UPIN