Doctor Name: | MR. MICHAEL THOMAS MUNGOVAN |
NPI Number: | 1457448821 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | 08001044 |
Business Practice Address: | 4705 Illinois Rd Ste 102 Fort Wayne, IN - 468045108 |
Business Phone Number: | 2604471067 |
Business Fax Number: | 2604470827 |
Mailing Address: | 4705 Illinois Rd, Suite 102 FORT WAYNE |
State: | IN |
Postal Code: | 468045114 |
Phone Number: | 2604471067 |
Fax Number: | 2604470827 |
NPI Enumeration Date: | 10/06/2006 |
NPI Last Update Date: | 01/31/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 08001044 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |