Provider Demographics
NPI:1063591048
Name:MONAHAN, MICHAEL L (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:MONAHAN
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 1:285 N EL CAMINO REAL STE 110
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5384
Mailing Address - Country:US
Mailing Address - Phone:760-632-0232
Mailing Address - Fax:760-753-2348
Practice Address - Street 1:317 N EL CAMINO REAL STE 502
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2816
Practice Address - Country:US
Practice Address - Phone:760-634-0232
Practice Address - Fax:760-753-2348
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 18544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 18544Medicare UPIN