Michaelsen, Mark R
Michaelsen, Mark R is an individual health care provider with primary practice located at 645 S Broadway Ave Suite 1, Tyler TX 75701-1676. He recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as his primary health care specialty. Michaelsen, Mark R can be contacted via phone (903) 593-5200.Contact Information
Primary practice address
645 S Broadway Ave Suite 1
Tyler TX 75701-1676
Phone: (903) 593-5200
Fax: (903) 535-9412
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Chiropractor | 111N00000X | 5712 | Texas |
Profile Details
| NPI number | 1902832686 |
|---|---|
| LBN Legal business name | Michaelsen, Mark R |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 24th, 2006 |
| Last updated | Apr 29th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902832686 | NPPES |
| Texas | MEDICAID | 039541001 |
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