Provider Demographics
NPI:1487721957
Name:MARCELL, MICHAEL R I (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:MARCELL
Suffix:I
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 1:1244 S PINELLAS AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3720
Mailing Address - Country:US
Mailing Address - Phone:727-937-2086
Mailing Address - Fax:727-939-2552
Practice Address - Street 1:1244 S PINELLAS AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3720
Practice Address - Country:US
Practice Address - Phone:727-937-2086
Practice Address - Fax:727-939-2552
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-7441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381282100 FLMedicaid
FL381282100 FLMedicaid
FLK2134 FLMedicare ID - Type Unspecified