Michael Clifford Basille, D.C.
Individual provider Active NPI Chiropractor · College Park, GA
NPI 1801929930 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1801929930
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHIR006552 (GA)
- Practice address
- 1624 Virginia Ave
College Park, GA 30337-2824 - Phone
- (404) 781-2225
- Fax
- (404) 781-2226
- NPI assigned
- Mar 14, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHIR006552 | GA | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CHIR006552 | GA | Yes |
Addresses
Primary practice location
1624 Virginia Ave
College Park, GA 30337-2824
Mailing address
PO Box 941188
Atlanta, GA 31141-0188
Phone (678) 701-2225
Other providers in College Park, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.