Provider Demographics
NPI:1427107341
Name:CRUZ, MIGUEL ANGEL (DC)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:CRUZ
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 1:390 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-3019
Mailing Address - Country:US
Mailing Address - Phone:828-682-6157
Mailing Address - Fax:828-682-6158
Practice Address - Street 1:390 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-3019
Practice Address - Country:US
Practice Address - Phone:828-682-6157
Practice Address - Fax:828-682-6158
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7908325Medicaid
NC90-0162064OtherCORP. ID
NC08325OtherNC STATE INS.