Provider Demographics
NPI:1780774638
Name:STATES, MICHAEL J (DC MS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:STATES
Suffix:
Gender:M
Credentials:DC MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 W A ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-4534
Mailing Address - Country:US
Mailing Address - Phone:308-534-3948
Mailing Address - Fax:
Practice Address - Street 1:1811 W A ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-4534
Practice Address - Country:US
Practice Address - Phone:308-534-3948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47072521300Medicaid
NE9720OtherBC/BS
NE9720OtherBC/BS
NE47072521300Medicaid