Provider Demographics
NPI:1235352196
Name:MAGGIO, MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MAGGIO
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 1:6507 JESTER BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8367
Mailing Address - Country:US
Mailing Address - Phone:512-231-9933
Mailing Address - Fax:
Practice Address - Street 1:6507 JESTER BLVD STE 107
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8367
Practice Address - Country:US
Practice Address - Phone:512-231-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606253OtherBCBS #
606253OtherBCBS TX
TX606253OtherBCBS #
TX609232Medicare ID - Type UnspecifiedTRAILBLAZER HEALTH TX MCB