Provider Demographics
NPI:1134344526
Name:PAUL, MICHAEL VANCE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VANCE
Last Name:PAUL
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 1:1219 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-5225
Mailing Address - Country:US
Mailing Address - Phone:501-332-3651
Mailing Address - Fax:501-332-2519
Practice Address - Street 1:1219 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-5225
Practice Address - Country:US
Practice Address - Phone:501-332-3651
Practice Address - Fax:501-332-2519
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor