Provider Demographics
NPI:1780743971
Name:MINGE, MICHAEL LEE II (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:MINGE
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-0607
Mailing Address - Country:US
Mailing Address - Phone:423-323-7691
Mailing Address - Fax:423-279-7850
Practice Address - Street 1:1323 HIGHWAY 394
Practice Address - Street 2:SUITE C
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617-4133
Practice Address - Country:US
Practice Address - Phone:423-323-7691
Practice Address - Fax:423-279-7850
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4278608OtherBCBST
TN103I358078Medicare PIN