Provider Demographics
NPI:1306052105
Name:HUGHES, MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HUGHES
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 1:610 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1907
Mailing Address - Country:US
Mailing Address - Phone:517-784-9101
Mailing Address - Fax:517-784-9103
Practice Address - Street 1:610 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1907
Practice Address - Country:US
Practice Address - Phone:517-784-9101
Practice Address - Fax:517-784-9103
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1302839Medicaid
MIPO3680001Medicare ID - Type Unspecified
MI1302839Medicaid