Doctor Name: | MICHAEL AMBROSE |
NPI Number: | 1538398680 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 038010043 |
Business Practice Address: | 605 N 12th St Mount Vernon, IL - 628642857 |
Business Phone Number: | 6182412212 |
Business Fax Number: | 6182412508 |
Mailing Address: | 605 N 12th St, MOUNT VERNON |
State: | IL |
Postal Code: | 628642857 |
Phone Number: | 6182412212 |
Fax Number: | 6182412508 |
NPI Enumeration Date: | 07/10/2009 |
NPI Last Update Date: | 06/28/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 038010043 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
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. |