Provider Demographics
NPI:1518966993
Name:SCHLEISMAN, MICHAEL EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:SCHLEISMAN
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 1:112 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51449-1604
Mailing Address - Country:US
Mailing Address - Phone:712-464-3149
Mailing Address - Fax:712-464-3148
Practice Address - Street 1:112 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:IA
Practice Address - Zip Code:51449-1604
Practice Address - Country:US
Practice Address - Phone:712-464-3149
Practice Address - Fax:712-464-3148
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA12913OtherBLUE CROSS BLUE SHIELD
IA0129130Medicaid
IA0129130Medicaid
T00806Medicare UPIN