Provider Demographics
NPI:1972677615
Name:MINETT, MICHAEL E (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:MINETT
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 1:8903 GLADES RD
Mailing Address - Street 2:SUITE A-11
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4074
Mailing Address - Country:US
Mailing Address - Phone:561-482-7575
Mailing Address - Fax:561-482-7724
Practice Address - Street 1:8903 GLADES RD
Practice Address - Street 2:SUITE A-11
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4074
Practice Address - Country:US
Practice Address - Phone:561-482-7575
Practice Address - Fax:561-482-7724
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3813002Medicaid
FL55651ZMedicare ID - Type UnspecifiedMEDICARE NUMBER
FL3813002Medicaid