Provider Demographics
NPI:1538197629
Name:VESELAK, MICHAEL SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:VESELAK
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 1:3801 LAS POSAS
Mailing Address - Street 2:SUITE 114
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1505
Mailing Address - Country:US
Mailing Address - Phone:805-482-0723
Mailing Address - Fax:805-482-9749
Practice Address - Street 1:3801 LAS POSAS
Practice Address - Street 2:SUITE 114
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1505
Practice Address - Country:US
Practice Address - Phone:805-482-0723
Practice Address - Fax:805-482-9749
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15637111N00000X
CADC15637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor