Provider Demographics
NPI:1538403563
Name:INNES, MICHAEL HAROLD (DC, DACBN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HAROLD
Last Name:INNES
Suffix:
Gender:M
Credentials:DC, DACBN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1049
Mailing Address - Country:US
Mailing Address - Phone:717-761-5077
Mailing Address - Fax:
Practice Address - Street 1:15 SAVIDGE RD
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061-9367
Practice Address - Country:US
Practice Address - Phone:717-512-1647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001916L111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology