Provider Demographics
NPI:1487751087
Name:YORK, MICHAEL RAY (DC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAY
Last Name:YORK
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 1:1614 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4937
Mailing Address - Country:US
Mailing Address - Phone:812-948-1391
Mailing Address - Fax:812-948-1393
Practice Address - Street 1:1614 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4937
Practice Address - Country:US
Practice Address - Phone:812-948-1391
Practice Address - Fax:812-948-1393
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000659A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100115710AMedicaid
IN100115710AMedicaid
U29969Medicare UPIN