Provider Demographics
NPI:1962632562
Name:MONASTERSKI-KLOS, MICHELLE ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:MONASTERSKI-KLOS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 ROSWELL ST NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2066
Mailing Address - Country:US
Mailing Address - Phone:770-428-4656
Mailing Address - Fax:
Practice Address - Street 1:487 ROSWELL ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2066
Practice Address - Country:US
Practice Address - Phone:770-428-4656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO08684111N00000X
GACHIR008486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G356460OtherMEDICARE OFFICE #
GA202I356460Medicare PIN