Provider Demographics
NPI:1588740070
Name:FIELDS, MICHAEL DOUGLAS JR (DC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:FIELDS
Suffix:JR
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 1:2143 GILMER RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2514
Mailing Address - Country:US
Mailing Address - Phone:903-234-2886
Mailing Address - Fax:
Practice Address - Street 1:2143 GILMER RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2514
Practice Address - Country:US
Practice Address - Phone:903-234-2886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
605821OtherBCBS
TX002035601Medicaid
605821OtherBCBS
609039Medicare ID - Type Unspecified