Provider Demographics
NPI:1932106523
Name:CEREFIN, MICHAEL T (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:CEREFIN
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 1:7855 S EMERSON AVE
Mailing Address - Street 2:STE Q
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8669
Mailing Address - Country:US
Mailing Address - Phone:317-884-2636
Mailing Address - Fax:317-884-2633
Practice Address - Street 1:7855 S EMERSON AVE
Practice Address - Street 2:STE Q
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8669
Practice Address - Country:US
Practice Address - Phone:317-884-2636
Practice Address - Fax:317-884-2633
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001590A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264470AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NO.
INU55067Medicare UPIN