Provider Demographics
NPI:1972554665
Name:POGORELEC, MICHAEL T (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:POGORELEC
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 1:1 S MAIN ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-2240
Mailing Address - Country:US
Mailing Address - Phone:973-405-6464
Mailing Address - Fax:
Practice Address - Street 1:1 S MAIN ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-2240
Practice Address - Country:US
Practice Address - Phone:973-405-6464
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00559000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor