Provider Demographics
NPI:1154314532
Name:PAGE, MICHAEL D (DC, DACRB)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:PAGE
Suffix:
Gender:M
Credentials:DC, DACRB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14810 E 42ND ST S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-4775
Mailing Address - Country:US
Mailing Address - Phone:816-461-5113
Mailing Address - Fax:816-836-0285
Practice Address - Street 1:14810 E 42ND ST S
Practice Address - Street 2:SUITE 100
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4775
Practice Address - Country:US
Practice Address - Phone:816-461-5113
Practice Address - Fax:816-836-0285
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003853111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO19388027OtherBLUE CROSS BLUE SHIELD
MOL073536Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MO19388027OtherBLUE CROSS BLUE SHIELD