Provider Demographics
NPI:1013250398
Name:PELUSO, MICHAEL (MS, LAC, DIPLAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:PELUSO
Suffix:
Gender:M
Credentials:MS, LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E MAIN ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4463
Mailing Address - Country:US
Mailing Address - Phone:406-926-1611
Mailing Address - Fax:
Practice Address - Street 1:127 E MAIN ST
Practice Address - Street 2:SUITE 314
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4463
Practice Address - Country:US
Practice Address - Phone:406-926-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT244171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist