Mr Mark R Michaelsen, DC | |
645 S Broadway Ave, Suite 1, Tyler, TX 75701-1676 | |
(903) 593-5200 | |
(903) 535-9412 |
Full Name | Mr Mark R Michaelsen |
---|---|
Gender | Male |
Speciality | Chiropractic |
Experience | 34 Years |
Location | 645 S Broadway Ave, Tyler, Texas |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1902832686 | NPI | - | NPPES |
039541001 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 5712 (Texas) | Primary |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Michaelsen Chiropractic Center, P.c. | 2062674278 | 2 |
Provider Name | Michaelsen Chiropractic Center, P.c. |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1053597906 PECOS PAC ID: 2062674278 Enrollment ID: O20120504000455 |
Mailing Address | Practice Location Address |
---|---|
Mr Mark R Michaelsen, DC 645 S Broadway Ave, Suite 1, Tyler, TX 75701-1676 Ph: (903) 593-5200 | Mr Mark R Michaelsen, DC 645 S Broadway Ave, Suite 1, Tyler, TX 75701-1676 Ph: (903) 593-5200 |
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