Provider Demographics
NPI:1639687791
Name:AQUINO, MICHAEL VINCENT (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:VINCENT
Last Name:AQUINO
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 1:22 THE COURTYARDS
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2111
Mailing Address - Country:US
Mailing Address - Phone:716-639-0925
Mailing Address - Fax:
Practice Address - Street 1:929 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-8113
Practice Address - Country:US
Practice Address - Phone:716-837-1507
Practice Address - Fax:716-837-0799
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor