Provider Demographics
NPI:1851446652
Name:BARDWELL, MICHAEL JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:BARDWELL
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 1:3000 WESTCHESTER AVENUE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577
Mailing Address - Country:US
Mailing Address - Phone:914-939-0101
Mailing Address - Fax:914-939-7755
Practice Address - Street 1:3000 WESTCHESTER AVENUE
Practice Address - Street 2:SUITE 203
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577
Practice Address - Country:US
Practice Address - Phone:914-939-0101
Practice Address - Fax:914-939-7755
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005541111N00000X
CT001053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU06498Medicare UPIN
NYX5S661Medicare ID - Type Unspecified