Provider Demographics
NPI:1669903746
Name:SHIFRIN, MIKHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:MIKHAEL
Middle Name:
Last Name:SHIFRIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:SHIFRIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2700 LIGHTHOUSE PT E STE 320
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4774
Mailing Address - Country:US
Mailing Address - Phone:443-692-7752
Mailing Address - Fax:
Practice Address - Street 1:2700 LIGHTHOUSE PT E STE 320
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4774
Practice Address - Country:US
Practice Address - Phone:443-692-7752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS04026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor