Provider Demographics
NPI:1932256112
Name:BIALAS, MICHAEL Z (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:Z
Last Name:BIALAS
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 1:1421 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:DUPO
Mailing Address - State:IL
Mailing Address - Zip Code:62239-1429
Mailing Address - Country:US
Mailing Address - Phone:618-799-8752
Mailing Address - Fax:618-286-6507
Practice Address - Street 1:1421 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:DUPO
Practice Address - State:IL
Practice Address - Zip Code:62239-1429
Practice Address - Country:US
Practice Address - Phone:618-799-8752
Practice Address - Fax:618-286-6507
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001023792111N00000X, 111NN1001X, 111NR0400X
IL111N00000X, 111NN1001X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8232006OtherBC BS OF ILLINOIS
IL152176OtherBC BS OF MISSOURI
IL628038OtherUNITED HEALTHCARE
IL208545Medicare ID - Type Unspecified
ILU94125Medicare UPIN
ILK04630Medicare ID - Type Unspecified