Provider Demographics
NPI:1295793651
Name:WEBB, MICHAEL L JR (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:WEBB
Suffix:JR
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 1:201 GEORGIAN PL
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-1610
Mailing Address - Country:US
Mailing Address - Phone:814-445-6440
Mailing Address - Fax:814-443-3242
Practice Address - Street 1:201 GEORGIAN PL
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1610
Practice Address - Country:US
Practice Address - Phone:814-445-6440
Practice Address - Fax:814-443-3242
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002239L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007926280001Medicaid
PA209878OtherUPMC
PA150196OtherHIGHMARK
PA209878OtherUPMC
T29652Medicare UPIN