Provider Demographics
NPI:1518049246
Name:MAGGIO, MICHAEL SALVATORE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SALVATORE
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 1:1100 LOMAS BLVD NW
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1863
Mailing Address - Country:US
Mailing Address - Phone:505-242-8400
Mailing Address - Fax:505-242-4340
Practice Address - Street 1:1100 LOMAS BLVD NW
Practice Address - Street 2:SUITE #1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1863
Practice Address - Country:US
Practice Address - Phone:505-242-8400
Practice Address - Fax:505-242-4340
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1323111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00KC37OtherBC/BS PROVIDER NUMBER