Provider Demographics
NPI:1649410630
Name:NAGEL, MICHAEL JUSTIN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JUSTIN
Last Name:NAGEL
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 1:801 BREWFIELD DR.
Mailing Address - Street 2:REDSKIN TRAIL
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895
Mailing Address - Country:US
Mailing Address - Phone:419-738-4373
Mailing Address - Fax:419-738-3780
Practice Address - Street 1:801 BREWFIELD DR.
Practice Address - Street 2:REDSKIN TRAIL
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895
Practice Address - Country:US
Practice Address - Phone:419-738-4373
Practice Address - Fax:419-738-3780
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor