Provider Demographics
NPI:1225077480
Name:HACZELA, MICHAEL JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:HACZELA
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 1:111 WAGNER RD
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-2457
Mailing Address - Country:US
Mailing Address - Phone:724-775-1214
Mailing Address - Fax:724-775-5262
Practice Address - Street 1:111 WAGNER RD
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-2457
Practice Address - Country:US
Practice Address - Phone:724-775-1214
Practice Address - Fax:724-775-5262
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007439-L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA302900OtherUPMC HEALTH PLAN
PA000480588OtherBLUE CROSS/BLUE SHIELD
PA7058073OtherCIGNA HEALTHCARE
PA01787749Medicaid
PA1020801OtherHEALTH AMERICA/HEALTH ASS
PA7059104OtherAETNA
PA7058073OtherCIGNA HEALTHCARE
PA01787749Medicaid