Provider Demographics
NPI:1871595595
Name:MONROE, MICHAEL KEVIN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KEVIN
Last Name:MONROE
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 1:25 INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:43162-1112
Mailing Address - Country:US
Mailing Address - Phone:614-879-5070
Mailing Address - Fax:614-879-5023
Practice Address - Street 1:25 INWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-1112
Practice Address - Country:US
Practice Address - Phone:614-879-5070
Practice Address - Fax:614-879-5023
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1750OtherSTATE LICENSE #
000000119775OtherANTHEM BC/BS
OH0855436Medicaid
44-00105OtherUNITED HEALTH CARE #
OH1750OtherSTATE LICENSE #
OH0709784Medicare PIN