Provider Demographics
NPI:1285748392
Name:TIRELLA, MICHAEL HENRY (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HENRY
Last Name:TIRELLA
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 1:141 OLD LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-4008
Mailing Address - Country:US
Mailing Address - Phone:518-783-3154
Mailing Address - Fax:518-783-3154
Practice Address - Street 1:141 OLD LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4008
Practice Address - Country:US
Practice Address - Phone:518-783-3154
Practice Address - Fax:518-783-3154
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY39171BMedicare UPIN