Provider Demographics
NPI:1801811880
Name:HEAD, MICHAEL DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:HEAD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3434 LEXINGTON AVE N
Mailing Address - Street 2:SUITE 900
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8069
Mailing Address - Country:US
Mailing Address - Phone:651-784-3396
Mailing Address - Fax:651-784-7247
Practice Address - Street 1:5922 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-5604
Practice Address - Country:US
Practice Address - Phone:651-784-3396
Practice Address - Fax:651-784-7247
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN231934OtherCCMI ID
MN35P22WIOtherBCBS OF MN CLINIC ID
MN7711328-00Medicaid
MN4400056OtherMEDICA
MN79279OtherUPIN FOR HEALTHPARTNERS
MN35P23HEOtherBCBS OF MN ID INDIVIDUAL
MN35P23HEOtherBCBS OF MN ID INDIVIDUAL
MN79279OtherUPIN FOR HEALTHPARTNERS
MNC04660Medicare PIN