Provider Demographics
NPI:1962507848
Name:MASSENGALE, MICHAEL LOREN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LOREN
Last Name:MASSENGALE
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 1:5392 AUTUMN HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6571
Mailing Address - Country:US
Mailing Address - Phone:801-302-3865
Mailing Address - Fax:
Practice Address - Street 1:1951 W 4700 S
Practice Address - Street 2:SUITE 2
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84118-1108
Practice Address - Country:US
Practice Address - Phone:801-969-4700
Practice Address - Fax:801-969-7217
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5248896-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor