Provider Demographics
NPI:1992773592
Name:DORFMAN, MICHAEL STEPHEN (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:DORFMAN
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 1:18551 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2663
Mailing Address - Country:US
Mailing Address - Phone:248-443-1995
Mailing Address - Fax:248-443-5573
Practice Address - Street 1:18551 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2663
Practice Address - Country:US
Practice Address - Phone:248-443-1995
Practice Address - Fax:248-443-5573
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMD002956111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95OH25140OtherBCBS
MI95OF373730OtherGROUP BCBS
MIMD002956OtherLICENSE
MI4732619Medicaid
MIG04709OtherBCN GROUP
MIMD002956OtherLICENSE
MIT33705Medicare UPIN