Provider Demographics
NPI:1568789840
Name:MIGONI, NATALIE JO (DC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:JO
Last Name:MIGONI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5704 BROAD BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-2212
Mailing Address - Country:US
Mailing Address - Phone:330-414-2496
Mailing Address - Fax:
Practice Address - Street 1:33560 DETROIT RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2030
Practice Address - Country:US
Practice Address - Phone:440-937-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000713612OtherANTHEM BCBS
OH000000713612OtherANTHEM BCBS