Provider Demographics
NPI:1811070493
Name:BAJSA, MICHAEL G (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:BAJSA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4543 SOUTH MANHATTAN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611
Mailing Address - Country:US
Mailing Address - Phone:813-831-8888
Mailing Address - Fax:813-831-6292
Practice Address - Street 1:4543 SOUTH MANHATTAN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611
Practice Address - Country:US
Practice Address - Phone:813-831-8888
Practice Address - Fax:813-831-6292
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 1683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89017Medicare ID - Type Unspecified