Provider Demographics
NPI:1568847572
Name:GAMPOLO, MICHAEL ANTHONY II (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:GAMPOLO
Suffix:II
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 1:2100 S CHICKASAW TRL STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8444
Mailing Address - Country:US
Mailing Address - Phone:407-504-0117
Mailing Address - Fax:
Practice Address - Street 1:2100 S CHICKASAW TRL STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-8444
Practice Address - Country:US
Practice Address - Phone:407-504-0117
Practice Address - Fax:407-504-0117
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor