Basic Information
Provider Information | |||||||||
NPI: | 1669132221 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MICHAEL PAPA,D.C.,P.A. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2632 W INDIANTOWN RD | ||||||||
Address2: |   | ||||||||
City: | JUPITER | ||||||||
State: | FL | ||||||||
PostalCode: | 334585889 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5617447373 | ||||||||
FaxNumber: | 8007835176 | ||||||||
Practice Location | |||||||||
Address1: | 10377 S US HIGHWAY 1 STE 101 | ||||||||
Address2: |   | ||||||||
City: | PORT ST LUCIE | ||||||||
State: | FL | ||||||||
PostalCode: | 349525630 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7723371300 | ||||||||
FaxNumber: | 8007835176 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/23/2021 | ||||||||
LastUpdateDate: | 01/19/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | OSWALD | ||||||||
AuthorizedOfficialFirstName: | ELAINE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
AuthorizedOfficialTelephone: | 5612363741 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | RN | ||||||||
NPICertificationDate: | 01/19/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |   |
No ID Information.