Provider Demographics
NPI:1770614190
Name:OVARES, PAUL J (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:OVARES
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 1:10060 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3831
Mailing Address - Country:US
Mailing Address - Phone:313-292-4200
Mailing Address - Fax:313-292-4242
Practice Address - Street 1:10060 PELHAM RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3831
Practice Address - Country:US
Practice Address - Phone:313-292-4200
Practice Address - Fax:313-292-4242
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2114495Medicaid
MIPO004420OtherCOMMERCIAL
MIPO004420OtherWORK COMP
MI0Q250292Medicare ID - Type Unspecified
MIPO004420OtherCOMMERCIAL