Provider Demographics
NPI:1841263340
Name:OTOUPALIK, MICHAEL EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:OTOUPALIK
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 1:11 MAREBLU
Mailing Address - Street 2:230
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3066
Mailing Address - Country:US
Mailing Address - Phone:949-643-1500
Mailing Address - Fax:949-643-1671
Practice Address - Street 1:11 MAREBLU
Practice Address - Street 2:230
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3066
Practice Address - Country:US
Practice Address - Phone:949-643-1500
Practice Address - Fax:949-643-1671
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16793111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16793OtherBLUE SHIELD
CADC 16793Medicare ID - Type UnspecifiedPART B PROVIDER