Provider Demographics
NPI:1316138308
Name:HEAD, MICHELLE KATHLEEN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:KATHLEEN
Last Name:HEAD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 BETHANY TPKE
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-4194
Mailing Address - Country:US
Mailing Address - Phone:570-470-6330
Mailing Address - Fax:570-253-4164
Practice Address - Street 1:952 BETHANY TPKE
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-4194
Practice Address - Country:US
Practice Address - Phone:570-253-5551
Practice Address - Fax:570-253-4164
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor