Provider Demographics
NPI:1861790545
Name:ROWE, MICHAEL JUSTIN (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JUSTIN
Last Name:ROWE
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 1:344 1ST ST
Mailing Address - Street 2:PO BOX 848
Mailing Address - City:WATERVLIET
Mailing Address - State:MI
Mailing Address - Zip Code:49098-5104
Mailing Address - Country:US
Mailing Address - Phone:269-519-8738
Mailing Address - Fax:
Practice Address - Street 1:3134 NILES RD
Practice Address - Street 2:UNIT B
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8652
Practice Address - Country:US
Practice Address - Phone:269-408-8439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2012-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor