Provider Demographics
NPI:1104909100
Name:FERLITA, MICHAEL HUGH SR (DC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:HUGH
Last Name:FERLITA
Suffix:SR
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 1:5911 HEIL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3752
Mailing Address - Country:US
Mailing Address - Phone:714-377-1602
Mailing Address - Fax:714-377-5722
Practice Address - Street 1:5911 HEIL AVE STE A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-3752
Practice Address - Country:US
Practice Address - Phone:714-377-1602
Practice Address - Fax:714-377-5722
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC16371Medicare ID - Type UnspecifiedLISCENCE NUMBER