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Individual
DR. MICHAEL TRENT FILLAT
Active
Individual
DR. MICHAEL TRENT FILLAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CA23248
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0232480
BLUE SHIELD
CA
01
—
330755425
FEDERAL TAX ID
CA
01
—
CA23248
STATE LICENSE NUMBER
CA
Enumeration date
06/30/2006
Last updated
01/15/2010
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