Provider Demographics
NPI:1700900073
Name:BISHOP, MICHAEL C (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:BISHOP
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BARTON BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2710
Mailing Address - Country:US
Mailing Address - Phone:321-633-1400
Mailing Address - Fax:321-637-7057
Practice Address - Street 1:400 BARTON BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2710
Practice Address - Country:US
Practice Address - Phone:321-633-1400
Practice Address - Fax:321-637-7057
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7721111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381340100Medicaid
FL381340100Medicaid