Provider Demographics
NPI:1295924306
Name:MICHAEL W UTMAN
Entity type:Organization
Organization Name:MICHAEL W UTMAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:UTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-833-4655
Mailing Address - Street 1:1809 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8235
Mailing Address - Country:US
Mailing Address - Phone:480-833-4655
Mailing Address - Fax:480-833-0029
Practice Address - Street 1:1809 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8235
Practice Address - Country:US
Practice Address - Phone:480-833-4655
Practice Address - Fax:480-833-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0935780OtherBCBS
AZAZ0935780OtherBCBS