Provider Demographics
NPI:1538276233
Name:YUSIM, MIKHAIL (DC)
Entity type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:
Last Name:YUSIM
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 1:3100 TIMMONS LN
Mailing Address - Street 2:STE 135
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5377
Mailing Address - Country:US
Mailing Address - Phone:713-355-5343
Mailing Address - Fax:
Practice Address - Street 1:3100 TIMMONS LN
Practice Address - Street 2:SUITE 135
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5377
Practice Address - Country:US
Practice Address - Phone:713-355-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV08090Medicare UPIN
TX612197Medicare PIN