Michael Thomas Mungovan, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

08001044 Issued in IN

Practice address

4705 Illinois Rd Ste 102
Fort Wayne, IN 46804-5108

Phone

(260) 447-1067

Fax

(260) 447-0827

NPI assigned

Oct 6, 2006

Last updated

May 29, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mungovan Chiropractic PC

  • Chiropractor
  • Fort Wayne, IN
  • NPI 1154533354
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559088000000",
    "number": "1457448821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 ILLINOIS RD",
            "address_2": "SUITE 102",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468045114",
            "telephone_number": "260-447-1067",
            "fax_number": "260-447-0827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 ILLINOIS RD STE 102",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468045108",
            "telephone_number": "260-447-1067",
            "fax_number": "260-447-0827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNGOVAN",
        "first_name": "MICHAEL",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2019-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IN",
            "license": "08001044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000343299",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00311763",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "226000A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christina Marie Mummert, O.D.
• Syed R. Mumtaz, M.D.
• Ankita Mundh
• Andrea Mundt, PHARMD
• Mungovan Chiropractic PC
• Irfan Munir
• Muneebah Munir, M.D
• Diana Munoz-Mendoza, M.D.
• Linda Genessis Munoz
• Tiana Munro

• Chiropractor in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Chiropractor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.