Provider Demographics
NPI:1770540635
Name:MCLOGAN, MICHAEL T (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:MCLOGAN
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 1:2990 ORO DAM BLVD E
Mailing Address - Street 2:SUITE A
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-5177
Mailing Address - Country:US
Mailing Address - Phone:530-533-3117
Mailing Address - Fax:530-533-5420
Practice Address - Street 1:2990 ORO DAM BLVD E
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5177
Practice Address - Country:US
Practice Address - Phone:530-533-3117
Practice Address - Fax:530-533-5420
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05981Medicare UPIN